Gout

Question 1

What is the Tx for gout in GP?

Answer 1

NSAID+PPI/Oral colchicine (1st line)
Oral corticosteroid/IM corticosteroid injection (2nd line)
Joint aspiration and intra-articular corticosteroids are an option in people with acute monoarticular gout and co-morbidity

Use depends on: patient preference, renal function and co-morbidities.

Question 2

Advice to patient with acute gout attack

Answer 2

Rest and elevate the limb.
Avoid trauma to the affected joint.
Keep the joint exposed and in a cool environment.
Consider the use of an ice pack or bed-cage.

Question 3

Investigations to perform after acute gout attack?

Answer 3

Serum uric acid (definitely)
HbA1c
Renal function
Lipid profile

Question 4

What are the indications for referral?

Answer 4

If suspect septic arthritis

Question 5

What treatment to prevent gout?

Answer 5

Allopurinol (1st line)
- Start at a low dose and titrate upwards (where tolerated) every four weeks until the serum uric acid (SUA) level is below 300 micromol/L.
Feboxustat (2nd line)
- Check LFT prior to starting

Consider prescribing colchicine when initiating or increasing the dose of a ULT as prophylaxis against acute attacks secondary to ULT, and continue for up to 6 months.