Monitoring
Patients should be monitored for recurrent attacks, the development of tophi, and radiographic changes.
In patients taking uric acid-lowering agents, follow up uric acid levels every 1 to 3 months initially, then every 6 to 12 months (target level <6 mg/dL). In the UK, annual monitoring of serum urate level is recommended for patients with gout who are continuing urate-lowering therapy after reaching their target serum urate level.[53]
Patients should be monitored for adverse effects of nonsteroidal anti-inflammatory drugs (NSAIDs) and colchicine, especially if they are used for prolonged periods. For NSAIDs, colchicine, and allopurinol, complete blood count, renal function tests, and liver function tests should be obtained every 3 to 6 months.
When initiating allopurinol, patients should be closely monitored for drug-induced hypersensitivity syndrome (fever, eosinophilia, widespread rash, facial edema, and multisystem failure).[140]
Long-term colchicine use may be associated with neuromyopathy. Probenecid may increase the risk of nephrolithiasis.[57]
Most of the above medications, including allopurinol, have multiple drug interactions that may require adjustments to medication dosages.
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