By switaschek, 7 July, 2020 If mod/severe CKD (stage ≥3): allopurinol, febuxostat preferred over probenecid; start lower dose, depending on CKD stage (allopurinol ≤100 mg/day, febuxostat ≤40 mg/day)2
By switaschek, 7 July, 2020 Allopurinol strongly preferred 1st-line agent in all pts; start 100 mg/day2,3
By switaschek, 7 July, 2020 Start low-dose xanthine oxidase inhibitors as 1st-line ULT, titrate to serum urate
By switaschek, 7 July, 2020 If pt unable to tolerate PO, use steroid (IM, IA) over IL-1 inhibitor or ACTH2
By switaschek, 7 July, 2020 Consider low-dose colchicine + anti-inflammatory (NSAID, steroid), per EULAR3
By switaschek, 7 July, 2020 Choose dose/duration by severity of flare, except colchicine; low-dose colchicine as effective as high-dose, tolerated better1,2
By switaschek, 7 July, 2020 Start 1st-line tx agent early based on pt factors (comorbidity, access, past experience, DDI);2 avoid colchicine and NSAIDs if severe renal failure;3 avoid colchicine if strong CYP3A4 or P-glycoprotein inhibitor3