IT Quiz Answer – September 26, 2024

A 43-year-old African American male presents for gout management. He has alcoholic cirrhosis and a 1-year history of gout that was managed with prednisolone during the past six flares. ​He reports no current symptoms and is not on any medications, with a physical exam showing no tophaceous deposits.​ 
 

Explanation: 

This patient has gout with multiple flares within a year. Heavy alcohol use is a major risk factor. He needs gout treatment with a uric acid-lowering medication. Allopurinol is the preferred agent. However, patients with African, Korean, Han Chinese, or Thai ethnic backgrounds should get genetic testing done prior to starting Allopurinol because carriers of the HLA-B5801 allele are at increased risk for Allopurinol hypersensitivity reaction, which can be severe and cause Stevens-Johnson syndrome, acute liver failure, and even death. 

Febuxostat is considered the second drug of choice. Pegloticase is used as a last resort or when patients have severe gout with bone erosions and tophaceous deposits and are refractory to the oral agents. Probenecid is not commonly used because of its lesser efficacy. It would be an option if patients have a contraindication or intolerance to Allopurinol and Febuxostat as long as their kidneys are healthy and they don't have advanced renal failure or uric acid kidney stones.
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