Gout
Chronic disease with deposition of monosodium urate crystals in joints and tissues with persistent hyperuricemia. Attack — acute arthritis, often of the great toe. Therapy goals: attack relief and lowering uricemia below 360 µmol/L (300 in tophaceous gout).
ICD-10 M102 drugs
Drugs used for this condition
- AAllopurinolFirst line · Xanthine oxidase inhibitorsFirst-line urate-lowering therapy in gout per ACR 2020 and EULAR 2017. Indications: recurrent attacks (≥ 2/year), tophi, radiographic gout, urolithiasis. Start 100 mg daily; titrate every 2–5 weeks to a target uric acid below 360 µmol/L (300 in tophaceous gout). Maintenance dose is usually 300–600 mg/day, and treat-to-target titration may reach 800 mg/day. Start under anti-inflammatory cover (colchicine or an NSAID) to prevent a mobilization flare. In high-risk groups (Han Chinese, Korean, Thai, and African-American patients), HLA-B*5801 testing before initiation is conditionally recommended – positive results raise severe cutaneous reaction risk (DRESS, SJS/TEN) 80-fold; use an alternative (febuxostat).
- AColchicineFirst line · Antigout agentsPer ACR 2020 and EULAR 2017, colchicine is a first-line option for acute gout attacks alongside NSAIDs and corticosteroids. Dose 1.0–1.2 mg at the first symptoms, then 0.5–0.6 mg one hour later. Max 1.8 mg on day 1. The old 'one tablet hourly until diarrhea' regimen caused frequent severe adverse effects and was abandoned per AGREE 2010. Long-term prophylaxis at urate-lowering therapy initiation: 0.5–1 mg daily for 3–6 months.
How to read tiers A–F
Evidence tiers belong to the drug-indication pair, not to the drug as a whole: the same substance can be A for one condition and F for another.
- AStrong evidence – first or second line in international guidelines
- BRecommended in selected cases
- CStudy data contradict each other
- DBenefit not proven, no documented harm
- FDocumented harm, or risk without benefit