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What is the best next step for this patient?",[215,221],{"type":216,"data":217},"free_text",{"readDurationInSeconds":218,"title":219,"text":220},18.133333333333333,"Pop Quiz: September 26, 2024","\u003Cp>\u003Cem>\u003Cspan>A 43-year-old African American male presents for gout management. He has alcohol-associated liver disease (ARD) and a 1-year history of gout that was managed with prednisolone during the past six flares. ​He reports no current symptoms and is not on any medications, with a physical exam showing no tophaceous deposits.​ \u003C\u002Fspan>\u003C\u002Fem>\u003C\u002Fp>\u003Cp>\u003Cspan>What would you recommend first?\u003C\u002Fspan>\u003Cbr>\u003Cbr>\u003Cspan>a. Start allopurinol, 50 mg daily\u003C\u002Fspan>\u003Cbr>\u003Cspan>b. Start febuxostat, 40 mg daily\u003C\u002Fspan>\u003Cbr>\u003Cspan>c. Start a pegloticase infusion every 2 weeks\u003C\u002Fspan>\u003Cbr>\u003Cspan>d. Check HLA-B5801\u003C\u002Fspan>\u003Cbr>\u003Cspan>e. Start probenecid\u003C\u002Fspan>\u003C\u002Fp>",{"type":216,"data":222},{"readDurationInSeconds":223,"title":224,"text":225},48.53333333333334,"Answer: d. Check HLA-B5801","\u003Cp>\u003Cspan>\u003Cstrong>Explanation:\u003C\u002Fstrong> \u003C\u002Fspan>\u003Cbr>\u003Cbr>\u003Cspan>This patient has gout with multiple flares within a year. Heavy alcohol use is a major risk factor. He needs gout treatment with a uric acid-lowering medication. Allopurinol is the preferred agent. However, patients with African, Korean, Han Chinese, or Thai ethnic backgrounds should get genetic testing done prior to starting Allopurinol because carriers of the HLA-B5801 allele are at increased risk for Allopurinol hypersensitivity reaction, which can be severe and cause Stevens-Johnson syndrome, acute liver failure, and even death. \u003C\u002Fspan>\u003Cbr>\u003Cbr>\u003Cspan>Febuxostat is considered the second drug of choice. Pegloticase is used as a last resort or when patients have severe gout with bone erosions and tophaceous deposits and are refractory to the oral agents. Probenecid is not commonly used because of its lesser efficacy. It would be an option if patients have a contraindication or intolerance to Allopurinol and Febuxostat as long as their kidneys are healthy and they don't have advanced renal failure or uric acid kidney stones.\u003C\u002Fspan>\u003Cbr>\u003Cspan lang=\"EN-US\">\u003C\u002Fspan>\u003Cspan>​\u003C\u002Fspan>\u003Cspan lang=\"EN-US\"> \u003C\u002Fspan>\u003Cspan>​\u003C\u002Fspan>\u003Cbr>\u003Cspan lang=\"EN-US\">\u003C\u002Fspan>\u003Cspan>​​\u003C\u002Fspan>\u003Cem>Not the answer you expected? \u003Cspan>Start our \u003C\u002Fspan>\u003C\u002Fem>\u003Ca href=\"https:\u002F\u002Fwww.medmastery.com\u002Fcourses\u002Fapproaching-joint-pain?utm_source=nonmember&utm_medium=email&utm_campaign=it376\">\u003Cem>\u003Cspan>Approaching Joint Pain\u003C\u002Fspan>\u003C\u002Fem>\u003C\u002Fa>\u003Cem>\u003Cspan> course now! This course will show you how a rheumatologist approaches joint pain and will give you the tools, tips, and skills necessary to solve and\u002For treat an arthritis case, at least until the specialist sees them!\u003C\u002Fspan>\u003C\u002Fem>\u003C\u002Fp>",{"courses":227,"showAwardsBelow":48},[],{"id":229,"name":230,"image":231,"profession":232,"relativeUrl":235,"specializations":236},1563,"Franz Wiesbauer, MD MPH","https:\u002F\u002Fmedmastery-backend-prod-kjbeds.s3.eu-west-1.amazonaws.com\u002Fmedia\u002Fimages\u002F9c43cef0-41ee-4005-9e4a-d8711c816401",{"name":233,"description":234},"Internist","Franz is the founder and CEO of Medmastery. He is an internist with a specialization in cardiology and a master’s in public health from Johns Hopkins University.","\u002Fteachers\u002Ffranz-wiesbauer-md-mph",[237,238,239,240,241],"Nephrology","Professional development","Cardiology","Ultrasound","Emergency medicine and critical care",72,"2m",[245,267,286],{"id":246,"title":247,"text":248,"image":249,"author":257,"path":260,"readDuration":261,"readDurationFormatted":262,"internal":263},1350,"How to Recognize INOCA (ANOCA) on an Exercise Stress Test ","Angina, abnormal stress test, clean coronaries—that's INOCA (or ANOCA), and it carries real risk. Learn to recognize and report it with exercise stress ECG.",{"alt":250,"title":251,"size":252,"location":254},"Illustration of the heart's coronary vasculature showing large coronary arteries and the extensive network of smaller vessels affected in INOCA (ischemia with nonobstructive coronary arteries).","",{"width":253,"height":253},1200,{"bucket":255,"key":256},"public-drupal-medmastery-assets-production","\u002F2026-05\u002FC17(1)_magazine image_0.png",{"id":229,"title":230,"relativeURL":235,"image":231,"professionLong":234,"profession":258,"weight":259},{"name":233},4,"\u002Fmagazine\u002Fexercise-stress-ecg-inoca",141,"3m",{"created":264,"updated":265,"published":266},1778115738,1778118425,1778118255,{"id":268,"title":269,"text":270,"image":271,"author":277,"path":279,"readDuration":280,"readDurationFormatted":281,"internal":282},1348,"Hyperlipidemia screening: who, when, & what to measure","Testing for hyperlipidemia can help you mitigate your patients' cardiovascular risk. Learn who to screen and when, which measures to request, and how to stratify risk.",{"alt":272,"title":251,"size":273,"location":275},"Lipid panel blood sample tubes used to test for hyperlipidemia in a laboratory setting",{"width":274,"height":274},600,{"bucket":255,"key":276},"\u002F2026-04\u002FC121_magazine image.png",{"id":229,"title":230,"relativeURL":235,"image":231,"professionLong":234,"profession":278,"weight":259},{"name":233},"\u002Fmagazine\u002Ftest-for-hyperlipidemia",246,"5m",{"created":283,"updated":284,"published":285},1777403036,1777572381,1777412421,{"id":287,"title":288,"text":289,"image":290,"author":295,"path":304,"readDuration":305,"readDurationFormatted":306,"internal":307},1347,"Outpatient care for COPD exacerbations","Most acute COPD exacerbations can be managed with outpatient treatment. Learn how to treat mild and moderate COPD exacerbations—and when to escalate care.",{"alt":291,"title":251,"size":292,"location":293},"Older patient using a handheld nebulizer to inhale bronchodilator medication during an acute COPD exacerbation",{"width":274,"height":274},{"bucket":255,"key":294},"\u002F2026-04\u002FC133(4)_ exacerbations_magazine image.png",{"id":296,"title":297,"relativeURL":298,"image":299,"professionLong":300,"profession":301,"weight":303},5365,"Siamak Moayedi, MD","\u002Fteachers\u002Fsiamak-moayedi-md","https:\u002F\u002Fmedmastery-backend-prod-kjbeds.s3.eu-west-1.amazonaws.com\u002Fmedia\u002Fimages\u002F9c43cf02-1064-4074-817b-0eb5de6ded74","Professor and Director of Medical Student Education, University of Maryland and Course Director, Essential and Critical Procedures, Emergency Medicine.",{"name":302},"Emergency medicine physician",1533,"\u002Fmagazine\u002Facute-copd-exacerbation-treatment",191,"4m",{"created":308,"updated":309,"published":310},1776705362,1776710540,1776710541,{"seo":312,"og":315},{"title":313,"description":314},"Gout treatment with alcohol-associated liver disease | Medmastery","Best next steps for patient with gout and alcohol-associated liver disease",{"title":313,"description":314,"image":316},null,{"id":318,"created":319,"updated":320,"published":321},1070,1723844689,1748267690,1723844488]