Aashi
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A 43-year-old man comes to the office seeking medical advice. His father was diagnosed with gout at the age of 45 years and now needs hemodialysis. His older brother is 50 years old and was diagnosed with gouty arthritis last year. The patient's past medical history is significant for hypertension, which is managed with atenolol. On physical examination, the patient is slightly obese. There are no obvious joint deformities. His range of motion is not restricted. The only significant finding on physical examination is some nodularity on palpation of the Achilles tendon on the left. His serum uric acid is 18 mg/dL (normal 2.5-7.5 mg/dL), and his urine uric acid is 850 mg/24 h (normal <800 mg/24 h on a regular diet). Treatment with allopurinol is started. In two weeks, the patient comes back complaining of a diffuse erythematous rash and itching. What is your next step?
(A) Stop allopurinol
(B) Stop atenolol
(C) Desensitization to allopurinol
(D) Give colchicine if an attack develops
(E) Repeat the uric acid level in one month
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| prathapdoctor
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desensitization to allopurinol.
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| robin082006
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D
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| AAzad
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stop allopurinol
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| sugandhna
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stop allopurinol
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| liwei
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FIRST TRY OTHER TREATMENTS
In patients with allopurinol hypersensitivity, one must try other available methods of lowering the serum uric acid level before pursuing desensitization
DESENSITIZATION TO ALLOPURINOL
When allopurinol treatment is deemed necessary, desensitization should be considered. Desensitization is generally safe and most patients can tolerate it. However, the patient and the family need to be informed of the risks
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| drashishmahajan
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stop allopurinol
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| Aashi
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Answer:
(C) Desensitization to allopurinol
Explanation:
This patient presents with asymptomatic hyperuricemia. Asymptomatic hyperuricemia is frequently seen in family members of patients with gout. Only 20% of hyperuricemic individuals will ever develop gout, so it is reasonable to start treatment only when attacks occur. In patients with a strong family history of tophaceous diseases or gout and renal problems, treatment with allopurinol should be started before articular or renal problems develop. In this patient, the treatment was started, but the course was complicated by a mild hypersensitivity reaction. Desensitization to allopurinol is indicated in mild allergic reactions, such as urticaria, but it would be considered dangerous in more severe hypersensitivity reactions, such as anaphylaxis. In this case, continuation of treatment with allopurinol is suggested based on the strong family history of gout with renal failure and painless deposits along the Achilles tendon, which could be the first manifestation of tophaceous disease. An increased urinary uric acid excretion is suggestive of a predisposition toward the development of renal stones.
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| fox
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I would wanna stop allopurinol
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