Rheumatology

For example, I have a patient who has frequent (monthly) large to medium joint flares (Knee, Ankle) with crystal proven disease. Did not tolerate colc...

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Why are gout flares common in hospitalized patients undergoing diuresis but not commonly observed in cancer patients with hyperuricemia resulting from tumor lysis syndrome?

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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?

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How would you manage a patient on pegloticase and immunomodulation in whom the uric acid has never dropped below 6?

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What is your approach to treating crowned dens syndrome?

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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?

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Is concomitant use of azathioprine and febuxostat safe from a bone marrow toxicity standpoint?

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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?

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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?

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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?

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At what point, if at all, do you decrease the frequency of or discontinue pegloticase infusions after achieving persistently low serum urate levels?

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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?

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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?

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Is febuxostat a safe alternative for patients who are HLA-B*58:01 positive and of Han Chinese descent?

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What is your approach to treating tophaceous gout in patients whose uric acid is below 5 prior to initiating uric acid lowering therapy?

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How do you approach adding colchicine to a patient who is on a stable statin regimen?

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How do you use colchicine for gout in patients with chronic kidney disease or end-stage renal disease on hemodialysis?

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Do you recommend allopurinol desensitization in gout patients who develop a rash on allopurinol therapy?

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Do you avoid PTH/PTHrP analogs in patients with recurrent/severe CPPD?

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Is there any utility in checking HLA-B*5801 in our Black and Asian patients who are already tolerating allopurinol?

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What is your approach for gout flare prophylaxis in patients with diabetes and advanced CKD?

Preference for low dose steroids vs attempting colchicine?

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Is it ever appropriate to reduce urate lowering therapy dose due to very low urate levels?

Are there implications of reducing urate too much?

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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...

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How do you counsel patients regarding the cardiovascular risk of febuxostat?

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How do you determine when to transition off pegloticase to other uric acid lowering therapies?

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Do you eventually stop urate-lowering therapy in gout patients with CKD who start hemodialysis?

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When have you found Dual-Energy CT most useful in evaluating for gout?

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How do you approach dosage changes of allopurinol as a patient's GFR decreases over time?

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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?