A case of gouty arthritis with tophi was admitted for operation. He accepted febuxostat as treatment in 榮總. The goal of therapy in an acute gout attack is prompt and safe termination of pain and disability. NSAID is the first-line therapy for most patients with acute gout if no contraindication. Usually, the duration of NSAID therapy is about 1 week. After clinical signs have completely resolved, NSAID may be stoped. However, due to inpaired renal function, both Colchicine and NSAID may be contraindicated. In this circumstance, glucocorticoids may be tried(IV, oral, or intraarticular according to clinical condition) if no contraindiation (such as infection). Besides, antihyperuricemic therapy is recommend in patients with a history of gout who have frequent and disabling attacks of gouty arthritis, clinical or radiographic signs of chronic gouty joint disease, tophi, unexplained renal insufficiency, recurrent nephrolithiasis, or urinary uric acid excretion >1100 mg/day. His Uric Acid is 5.0. Antihyperuricemic therapy should be adjusted to a dose to keep serum urate <6 mg/dL. Allopurinol and febuxostat may be prescribed, but the dose should adjusted according to renal function. In the mean time, please control underline disease as your experience. If necessary, you may consult rheumatologist for further evaluation and suggestion.
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