Initiating Allopurinol During Acute Gout Attacks

Evidenzbasierte Empfehlung

The American College of Rheumatology recommends starting urate-lowering therapy during an acute gout attack, provided effective anti-inflammatory treatment is established, with a strength of evidence C 1, 2

Effective anti-inflammatory therapy must be established before starting Allopurinol, such as NSAIDs, colchicine, or corticosteroids 1, 2
Prophylactic therapy with colchicine 0.5-1 mg/day for at least 6 months should be started simultaneously 3, 4
A low starting dose of Allopurinol, up to 100 mg daily, is recommended 1, 2

The EULAR Guidelines (2017) note that the limited patient numbers in studies do not allow definitive conclusions, and data with Allopurinol 200-300 mg may not be transferable to more potent urate-lowering medications (febuxostat, combination therapies) 3, 4

The American College of Rheumatology recommends starting Allopurinol at a low dose, 100 mg daily, and titrating slowly every 2-5 weeks until the target uric acid level is reached, with close monitoring of uric acid levels and liver function 1, 2, 5

Starting Allopurinol without simultaneous prophylaxis increases the risk of further attacks significantly 3, 4
Using too high a starting dose (>100 mg) increases the risk of triggering an attack and hypersensitivity reactions 1, 2
Stopping prophylaxis too early (<6 months) shows less benefit than 6-month versus 8-week prophylaxis 3, 4
Stopping at 300 mg Allopurinol, as more than half of patients do not reach the uric acid target with ≤300 mg 1, 2, 5