Allopurinol for chronic gout

Does the initiation of urate-lowering treatment during an acute gout attack prolong the current episode and precipitate recurrent attacks: a systematic literature review

“…For example, while the British Society for Rheumatology (BSR) and European League Against Rheumatism (EULAR) guidelines suggest commencing ULT 1–2 weeks after the acute attack has resolved, the 2012 American College of Rheumatology (ACR) guidelines suggest that ULT may be started during an acute attack [1–3]. However, these recommendations are discordant, and the latest Cochrane review did not examine the effect of ULT initiation during an acute attack of gout on its duration and severity [4]. Thus, further research is required to examine whether ULT can be initiated during an acute gout attack, without unduly prolonging the index episode.…”

Latest guidance on the management of gout

“…A lower dose is recommended for people with renal impairment (see table 1), and it is suggested that serum uric acid and renal function should be monitored every three months in the first year and then annually 2627. One recent study suggests that gradual titration of the dose upwards from an appropriate starting dose can help achieve the target serum uric acid, without increasing adverse effects 28…”

Clinical experience with the interleukin-1β blocker canakinumab in patients with chronic tophaceous gout: abolishment of arthritis and prevention of exacerbations when allopurinol is used

“…Интересно, что возможности препарата в отношении как достижения нор-моурикемии, так и редукции тофусов, частоты приступов артрита изучены недостаточно и уровень доказательности подобных исследований колеблется от низкого до умерен-ного [24]. Результаты последнего Кокрановского обзора [24] позволяют констатировать сопоставимое влияние аллопу-ринола и бензбромарона на сывороточный уровень МК, больший антигиперурикемический эффект аллопуринола по сравнению с плацебо и меньший по сравнению с фебук-состатом. Тем не менее исследований, в которых сравнива-лись бы максимально высокие дозы аллопуринола и других препаратов, мы не обнаружили.…”