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Rheumatology

Crystal Arthritis   

Questions discussed in this category

Why are gout flares common in hospitalized patients undergoing diuresis but not commonly observed in cancer patients with hyperuricemia resulting from tumor lysis syndrome?
2 Answers available
How would you manage gout with hyperuricemia >10 mg/dl despite the maximum dose of allopurinol plus probenecid and a prior allergic reaction to pegloticase?
2 Answers available
How would you manage a patient on pegloticase and immunomodulation in whom the uric acid has never dropped below 6?
1 Answer available
What is your approach to treating crowned dens syndrome?
2 Answers available
Do you ever taper or stop urate lowering therapy in patients who have had no gout flares and serum urate persistently below 6 mg/dl?
In patients with CKD, does urate lowering therapy have an effect (positive or negative) on progression of CKD?
1 Answer available
Is concomitant use of azathioprine and febuxostat safe from a bone marrow toxicity standpoint?
4 Answers available
How do you approach urate-lowering therapy in patients with advanced chronic kidney disease?
What doses of allopurinol do you use, and how frequently do you titrate the dose?
1 Answer available
How would you approach the management of a patient with tophaceous gout who consistently has a serum uric acid under 5 on allopurinol but continues to experience gout flares?
2 Answers available
What is your approach to urate lowering therapy in patient with gout who is on azathioprine (for example, for transplant), where allopurinol and febuxostat are both contraindicated?
1 Answer available
At what point, if at all, do you decrease the frequency of or discontinue pegloticase infusions after achieving persistently low serum urate levels?
1 Answer available
How do you approach transaminase elevations with use of allopurinol in gout?
Do you rechallenge with lower dose? What is your tolerance for mild persistent transaminitis?
1 Answer available
Do you use IL-1 inhibitors to prevent flares of gout or CPPD in patients who experience flares despite prophylaxis with colchicine, NSAIDs, and/or low-dose prednisone?
2 Answers available
Are there certain patients in whom you would avoid initiation of ULT during an acute gout flare?
This question is part of a collaboration with RheumMadness and is specifically in reference to: ULT During Gout Flare.
2 Answers available
Is febuxostat a safe alternative for patients who are HLA-B*58:01 positive and of Han Chinese descent?
1 Answer available
What is your approach to treating tophaceous gout in patients whose uric acid is below 5 prior to initiating uric acid lowering therapy?
1 Answer available
How do you approach adding colchicine to a patient who is on a stable statin regimen?
2 Answers available
How do you use colchicine for gout in patients with chronic kidney disease or end-stage renal disease on hemodialysis?
2 Answers available
Do you recommend allopurinol desensitization in gout patients who develop a rash on allopurinol therapy?
2 Answers available
Do you avoid PTH/PTHrP analogs in patients with recurrent/severe CPPD?
2 Answers available
Is there any utility in checking HLA-B*5801 in our Black and Asian patients who are already tolerating allopurinol?
1 Answer available
What is your approach for gout flare prophylaxis in patients with diabetes and advanced CKD?
Preference for low dose steroids vs attempting colchicine? 
1 Answer available
Is it ever appropriate to reduce urate lowering therapy dose due to very low urate levels?
Are there implications of reducing urate too much?
1 Answer available
Do you screen for HLA-B*5801 prior to starting allopurinol in patients of backgrounds other than Asian or African-American?
Specifically in patients of Vietnamese background? An association has been shown between HLA-B*5801 and the risk of allopurinol hypersensitivity react...
1 Answer available
How do you counsel patients regarding the cardiovascular risk of febuxostat?
1 Answer available
How do you determine when to transition off pegloticase to other uric acid lowering therapies?
1 Answer available
Do you eventually stop urate-lowering therapy in gout patients with CKD who start hemodialysis?
1 Answer available
When have you found Dual-Energy CT most useful in evaluating for gout?
3 Answers available
How do you approach dosage changes of allopurinol as a patient's GFR decreases over time?
2 Answers available
Do you correct the synovial fluid white blood cell count for red blood cells, and if so, is there a rough approximation/equation you use?
2 Answers available
In gout, do MSU crystals form only in tissue, or are there circulating microcrystals of MSU within blood vessels?
If so, does this have clinical significance?
2 Answers available
Is it ever appropriate to initiate a higher initial dose of allopurinol (such as 300mg daily) than is typically recommended in gout patients at low risk of allopurinol hypersensitivity syndrome and severe hyperuricemia?
2 Answers available
What are the most effective therapies for CPPD with a "pseudo-RA" pattern?
1 Answer available


Papers discussed in this category

The Journal of arthroplasty, 2008-02
Determining "true" leukocytosis in bloody joint aspiration.
The American journal of medicine, 1984-01
Severe allopurinol toxicity. Description and guidelines for prevention in patients with renal insufficiency.
Arthritis Rheum,
Starting dose is a risk factor for allopurinol hypersensitivity syndrome: a proposed safe starting dose of allopurinol.
Rheumatology (Oxford), 2021 Jan 07
Dual-energy computed tomography versus ultrasound, alone or combined, for the diagnosis of gout: a prospective study of accuracy.
Clinical and experimental rheumatology, 2018
Update on imaging in gout: contrasting and comparing the role of dual-energy computed tomography to traditional diagnostic and monitoring techniques.
The Journal of rheumatology, 2004-12
Colchicine for prophylaxis of acute flares when initiating allopurinol for chronic gouty arthritis.
The New England journal of medicine, 2018-03-29
Cardiovascular Safety of Febuxostat or Allopurinol in Patients with Gout.
Lancet, 2020 Nov 09
Long-term cardiovascular safety of febuxostat compared with allopurinol in patients with gout (FAST): a multicentre, prospective, randomised, open-label, non-inferiority trial.
JAMA, 2011-08-17
Efficacy and tolerability of pegloticase for the treatment of chronic gout in patients refractory to conventional treatment: two randomized controlled trials.
Journal of clinical rheumatology : practical reports on rheumatic & musculoskeletal diseases, 2014-12
Infusion-related reactions with pegloticase, a recombinant uricase for the treatment of chronic gout refractory to conventional therapy.
Rheumatology and therapy, 2019-06
Use of Pre-Infusion Serum Uric Acid Levels as a Biomarker for Infusion Reaction Risk in Patients on Pegloticase.
Curr Rheumatol Rep, 2022 Feb 15
Expert Opinion on Pegloticase with Concomitant Immunomodulatory Therapy in the Treatment of Uncontrolled Gout to Improve Efficacy, Safety, and Durability of Response.
J Rheumatol, 2020 Sep 15
Pegloticase in Combination With Methotrexate in Patients With Uncontrolled Gout: A Multicenter, Open-label Study (MIRROR).
Pharmacotherapy, 2020 Jan 20
Drug Interaction Between Febuxostat and Thiopurine Antimetabolites: A Review of the FDA Adverse Event Reporting System and Medical Literature.
Drug Des Devel Ther, 2014 Feb 17
Efficacy and safety of febuxostat in the treatment of hyperuricemia in stable kidney transplant recipients.
Arthritis care & research, 2012-10
2012 American College of Rheumatology guidelines for management of gout. Part 1: systematic nonpharmacologic and pharmacologic therapeutic approaches to hyperuricemia.
Joint Bone Spine, 2015 Dec 18
Risk of cutaneous adverse events with febuxostat treatment in patients with skin reaction to allopurinol. A retrospective, hospital-based study of 101 patients with consecutive allopurinol and febuxostat treatment.
Arthritis research & therapy, 2013-02-01
Rilonacept in the treatment of acute gouty arthritis: a randomized, controlled clinical trial using indomethacin as the active comparator.
Arthritis Rheumatol, 2021 Jul 07
A Randomized, Phase II Study Evaluating the Efficacy and Safety of Anakinra in the Treatment of Gout Flares.
Ann Rheum Dis, 2012 May 14
Canakinumab for acute gouty arthritis in patients with limited treatment options: results from two randomised, multicentre, active-controlled, double-blind trials and their initial extensions.
Mol Biol Rep, 2021 Jun 01
The role of Interleukin-1 receptor antagonist as a treatment option in calcium pyrophosphate crystal deposition disease.
Curr Rheumatol Rep, 2014 Feb
Anti-interleukin-1 therapy in the management of gout.
Pharmacotherapy, 2013 Apr 03
Role of interleukin-1 inhibitors in the management of gout.
Arthritis and rheumatism, 2008-11
Resolution of gouty tophi after twelve weeks of pegloticase treatment.
Arthritis Rheumatol, 2020 Jan
Effects of Conventional Uric Acid-Lowering Therapy on Monosodium Urate Crystal Deposits.
Arthritis Care Res (Hoboken), 2020 May 11
2020 American College of Rheumatology Guideline for the Management of Gout.
Arthritis Rheum, 2002 Aug
Effect of urate-lowering therapy on the velocity of size reduction of tophi in chronic gout.
Arthritis Rheumatol, 2022 Dec 16
A Randomized, Placebo-Controlled Study of Methotrexate to Increase Response Rates in Patients with Uncontrolled Gout Receiving Pegloticase: Primary Efficacy and Safety Findings.
Arthritis Rheum, 1972 Mar-Apr
The influence of temperature on the solubility of monosodium urate.
Arthritis Rheumatol, 2023 Mar 10
Amplification of Inflammation by Lubricin Deficiency Implicated in Incident, Erosive Gout Independent of Hyperuricemia.
Frontiers in medicine, 2022 Jan 24
Crowned Dens Syndrome: A Case Report and Literature Review.
Cancer pathogenesis and therapy, 2023 Jul 20
Rasburicase in treating tumor lysis syndrome: An umbrella review.

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