[1] Gout TO REDO

Question 1

What is gout?

Answer 1

Gout is a common form of arthritis where crystals form in and around joints, causing pain, swelling, and redness.

Question 2

What causes gout?

Answer 2

It is the body’s reaction to crystal deposits in joints

Question 3

What are the risk factors for gout?

Answer 3

• Alcohol
• Diet
• Stress or injury
• Medication
• Cancer
• Other medical conditions
• Genetics

Question 4

What medical conditions can cause gout?

Answer 4

• Hypertension
• Diabetes
• Obesity
• Psoriasis
• Kidney disorders

Question 5

What drugs increase the risk of the development of gout?

Answer 5

• Diuretics
• Anti-hypertensives
• Aspirin
• Warfarin
• Cytotoxics

Question 6

What are the symptoms of gout?

Answer 6

• Sudden, intense pain the joint, typically big toe or ankle, but sometimes knee and/or wrist
• Swelling, inflammation, and a feeling that the joint is very hot
• Extreme tenderness of joint
• Red/purple skin around the joint
  
  • Alternating chills and fever
    *

Question 7

What should be considered in the management of people with gout mild symptoms and high risk of adverse effects?

Answer 7

Self care, rather than a specific drug treatment

Question 8

What drugs should be used if drug treatment is necessary in gout?

Answer 8

NSAIDs (diclofenac, indometacin, or naproxen) ASAP

Question 9

How long should NSAID treatment be continued in gout?

Answer 9

48 hours after attack has resolved

Question 10

What is used in the drug management of gout if NSAIDs are contraindicated, not tolated, or have been ineffective in previous attacks?

Answer 10

Oral colchicine

Question 11

What drug is used in the management of gout if NSAIDS and colchicine are contraindicated?

Answer 11

Systemic corticosteroids

Question 12

What drug can be given in addition to other drug treatments in gout?

Answer 12

Paracetamol, with or without codeine

Question 13

What self-care measures can be used in gout?

Answer 13

• Rest and elevation
• Avoid trauma of affected joint
• Keep joint in cool environment by not covering, and using an ice pack
• Discuss lifestyle issues, such as weight loss, exercise, diet, alcohol consumption, and fluid intake

Question 14

How can gout be prevented?

Answer 14

• Lifestyle changes
• Allipurinol

Question 15

What lifestyle changes can help improve gout?

Answer 15

• Aim for ideal body weight, but avoid crash dieting and high protein/low carb diets
• Eat sensibly, restricting amount of red meat and avoiding high protein intake
• Drink alcohol sensibly, avoid binge drinking, and restrict consumption to under recommended units
• Avoid dehydration
• Limit consumption of sugary drinks and snacks
• Regular exercise, but avoid intense muscular exercise and trauma to joints
• Stop smoking
• Consider taking vitamin C supplements

Question 16

When is allopurinol in gout indicated?

Answer 16

If >1 attack in 12 months, tophi, or renal stones

Question 17

What is the aim of allopurinol in gout?

Answer 17

Reduce attacks and prevent damage caused by crystal deposition

Question 18

What dose of allopurinol is used in gout?

Answer 18

Titrate from 100mg/24 hours, increasing every 4 weeks until plasma urate <0.3mmol/L

Question 19

What are the side effects of allopurinol?

Answer 19

• Rash
• Fever
• Decreased WCC
• May trigger an attack of gout

Question 20

What should be done due to the potential for starting allopurinol triggering an attack of gout?

Answer 20

Should wait 3 weeks after acute episode before starting, and cover with regular NSAID for up to 6 weeks

Question 21

Can allipurinol be stopped once started?

Answer 21

It should be avoided

Question 22

What is the alternative to allipurinol if it is contraindicated or not tolerated?

Answer 22

Febuxostat

Question 23

What are the complications of gout?

Answer 23

• Tophi
• Kidney stones

Question 24

What are tophi?

Answer 24

Urate deposits appearing as small white lumps under the skin, especially on ears, fingers, and elbows