Drug prophylaxis

Allopurinol (a xanthine oxidase inhibitor) is the drug of choice.

Dose: 100-300 mg daily

Indications:

• frequent acute attacks

• tophi or chronic gouty arthritis

• renal stones or uric acid nephropathy

• hyperuricaemia

Beware of renal insufficiency and elderly patients—use lower doses. Method

• Commence 4 weeks after last acute attack.

• Start with 100 mg daily and increase by 100 mg daily after each month.

• Check uric acid level after 4 weeks: aim for level < 0.38 mmol/L

• Add colchicine 0.5 mg bd for 6 months (to avoid precipitation of gout) or indomethacin 50 mg bd.

The spondyloarthropathies

The spondyloarthropathies are a group of disorders with common characteristics affecting the spondyles (vertebrae) of the spine. It is appropriate to regard them as synonymous with the seronegative spondyloarthropathies in contradistinction to rheumatoid arthritis, which is seropositive and affects the cervical spine only. Apart from back pain this group tends to present with oligoarthropathy in younger patients.

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