Clinical Pearl of the Month – Gout Treatment in 49-year-old Chinese American man

Gerard Kiernan, MD, FAAFP, FHMClinical Pearls, Emergency Medicine, Family Medicine, Guideline Knowledge Check, Internal Medicine, Nurse Practitioner, Pediatric Medicine, Urgent Care

Gout Case - 49-year-old chinese-american man with gout

Gout Treatment of a 49-year-old Chinese-American Man

Clinical Pearls of Wisdom Q&A Case

Gout affects 8.3 million Americans according to NHANES 2007–2008, roughly 3.9% of the U.S. population. Gout has significant impact on physical function, productivity, health-related quality of life and health care costs.

Compared to whites, racial/ethnic minorities have higher prevalence of gout and there is a wide variation in the prevalence of gout in various populations in the Asia‐Pacific region.  There's something else as well.

In the following gout treatment case, we'll glean a pearl of wisdom about assessing gout risk and applying gout treatment.

Gout Treatment Case:

A 49-year-old Chinese American man was recently treated for a recurrent gout flare in his right first metatarsal-phalangeal joint. He was treated with naproxen sodium and colchicine, and his flare resolved.

Previously, he had painful ureterolithiasis, and stone analysis revealed the stones to be uric acid stones.

His serum uric acid level is 9 mg/dL. His prior medical history is significant for hypertension, for which he takes amlodipine. He has normal renal function and his creatinine is 0.9 mg/dL.

Due to his recurrent gout and hyperuricemia, uric acid lowering therapy is planned.

Question:

What is the correct next step in the gout treatment of this patient?

Answer Options:

Start allopurinol 100mg daily.

Initiate treatment with probenecid 250mg twice daily.

Start allopurinol 300mg daily.

Test patient for the human leukocyte antigen (HLA)-B*58:01 allele.

See the Answer:


About the Author:

Gerard Kiernan, MD, FAAFP, FHM is a Dartmouth-Hitchcock Clinic hospitalist in Keene, NH. He attended the University of Rochester School of Medicine and Dentistry, followed by a Family Medicine residency at the University of Wisconsin, Madison, where he was a chief resident. Dr. Kiernan is a Lean Six Sigma Greenbelt and has led hospital medicine quality improvement efforts. He is a fellow of both the American Academy of Family Physicians and the Society of Hospital Medicine. He has achieved the Recognition of Focused Practice in Hospital Medicine offered through the AAFP and ABIM via their joint examination pathway.

About Clinical Pearl of the Month:

Med-Challenger's Clinical Pearl Blog Series is a recurring segment of Med-Challenger's popular Medical Education Blog. Med-Challenger provides online medical education products and services to physicians, nurses, and other medical specialists as well as medical training programs and healthcare groups world-wide via its web-based medical education library and world-class assessment platform at challengercme.com.

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Gout Case - Increased Gout Risk in Patients of Asian Ancestry

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