Patients often stop allopurinol or febuxostat when a gout flare starts, believing it caused the attack. Stopping makes urate fluctuate further and prolongs the problem. Established practice is to continue urate-lowering therapy at the current dose and treat the flare separately with colchicine, an NSAID or a glucocorticoid as appropriate.
Flares are common in the first months of urate lowering, which is why prophylaxis is usually given when therapy starts.
- Tell patients not to stop urate-lowering therapy during a flare.
- Treat the flare separately with colchicine, an NSAID or a glucocorticoid.
- Expect more flares in the early months of urate lowering.
- Use flare prophylaxis when starting or increasing therapy.
Why it matters
Stopping the drug during a flare is the commonest way patients undo their own treatment.
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