CNS OTC - Gout Flashcards
Define Gout.
Purine metabolism disorder characterised by a raised uric acid level in blood and deposition of urate crystals in joints and other tissues e.g. soft connective tissues/ urinary tract.
What are the symptoms of gout? (4)
Inflammation arthritis of single joint
Painful and red
Skin peeling
Attacks joints in extremities
What are the 3 phases of gout? (3)
Asymptomatic hyperuricaemia.
Interval/ intercritical gout (period with acute attacks of gouty arthritis)
Chronic tophaceous gout (nodules affecting joints)
What are the risk factors of Gout?
Impaired renal function
Hyperuricaemia (CVD, renal disease, diabetes, obesity, metabolic syndrome, dyslipidaemia, severe psoriasis, alcoholism and use of drugs (diuretics).
What are the complications of Gout? (3)
Tophi
Development of secondary infection.
Hyperuricaemia-induced renal disease (acute/chronic urate nephropathy)
What is the prognosis of Gout? (2)
1st acute attacks subside in 3-10 days.
Recurrent acute episodes/development of chronic gout = progressive joint damage, pain and disability.
Explain the diagnosis of Gout. (2)
Based on clinical hx and examination.
Serum uric acid level (limited use)
What are the physical symptoms of Gout? (6)
Max inflammation developing within 1 day on onset.
Monoarthritis attack
Redness over affected joint
Unilateral attack on first metatarsophalangeal (big toe)
Tophus (proven/suspected)
Hyperuricaemia (not visible)
What are the treatment options for Gout?
Severity?
Previous attacks?
Which drugs have been tried? (NSAIDs, allopurinol)
Assess risk factors (diuretics, alcohol, diet and obesity)
Associated conditions (HPT, Diabetes, CVD)
CV risk assessment (after attack)
Mild symptoms: self care
1st line: NSAIDs = Ibuprofen OTC ASAP and continue until 48 hrs after attack has resolved.
I’d required regularly, refer for co-Rx of PPI.
If NSAIDs is c/i/ not tolerated/ineffective = refer for colchicine/steroids.
Add paracetamol with or without codeine in addition to other drugs tx or alone if NSAIDs are c/i.
Don’t stop allopurinol or febuxostat during an acute attack if gout is established.
What lifestyle advice is given to Gout px? (7)
Rest + elevate limb = avoid joint trauma.
Keep joint cook by not covering (with a sock, shoe or bed clothing) and use ice pack.
Aim for IBW - take regular exercise but avoid strenuous muscular exercise and joint trauma.
Restrict amount of red meat and avoid high protein intake.
Drink alcohol sensibly - avoid binge drinking alcohol consumption (14 units, 2 alcohol free days a week)
Avoid dehydration
Stop smoking
When would you consider offering ULT for Gout? (5)
Multiple or troublesome flares.
CKD Stage 3-5 (GFR G3 to G5)
Diuretics
Tophi
Chronic Gouty Arthritis
What tx options can be given for gout prevention? (2)
Allopurinol (POM) or Febuxostat - start 2-4 weeks after inflammation has settled.
How should allopurinol/Febuxostat be initiated? (5)
Titrated dose every few weeks until serum uric acid levels < 360mcmol/L (or < 300 if frequent flares and arthritis)
When starting allopurinol, a low dose NSAIDs (+PPI) is often co-Rx or low dose colchicine at least 1 month to prevent acute attacks.
Lifelong and regular monitoring needed.
Allopurinol or Febuxostat may cause acute attacks of gout after starting tx and for some weeks after.
Counsel: start anti-inflammatory tx ASAP and don’t stop allopurinol or Febuxostat during acute attacks.
When would you consider referring a patient with Gout? (5)
Uncertain diagnosis or underlying systemic illness (e.g. RA or connective tissue disorder)
Pregnancy or < 25 yrs
Allopurinol or Febuxostat is at max dose but a person still having recurrent attacks of gout.
Persistent symptoms during an acute attack despite mac doses of anti-inflammatory medication.
C/I to NSAIDs or available OTC tx
