Gout 🦶

Question 1

Define Gout

Answer 1

Inflammatory arthiritis
Rheumatic condition with symptoms of joint pain, swelling and redness.

Question 2

What is the major risk factor for Gout

Answer 2

Hyperuricaemia

Question 3

What is hyperuricaemia?

How does it occur?

Answer 3

Deposition of urate crystals in and around thr joints

Occurs when there is increase synthesis of purine precursors of urine and and/or decrease renal elimination of uric acid.

Question 4

Risk Factors for Gout

Answer 4

Age
Male sex
Diet > purine rich foods
Reduced renal excretion = concomitant meds OR obesity OR renal impairment

Genetics

Question 5

Pathophysiology of Gout

Disorder or purine metabolism, where uric acid is thr product

Answer 5

Overproduction of uric acid

Underexcretion of uric acid

Question 6

Diagnostic features of GOUT

Answer 6

Features:

1. Articular involvement
2. Rapid onset of severe pain and swelling
3. Erythema
4. Male gender

Question 7

Treatment of Gout

NON PHARMACOLOGICAL

Answer 7

1. Avoid dietary triggers
2. Reduce alcohol consumption
3. Keep hydrated
4. Implement weight loss program

Question 8

Treatment of Gout

PHARMACOLOGICAL =

GOUT FLARES

Answer 8

First line = NSAIDS, Colchicine

Second line = corticosteroids

Question 9

Advice for corticosteroid INTRA ARTICULAR INJ

Answer 9

1. Don’t give > 4 inj / year into an single joint = risk of cartilage damage
2. Avoid future inj if there is no response after 2 consecutive inj
3. Dont give inj to big toe = painful

Question 10

Indications of use for
Prophylatic treatment

Answer 10

1. Tophaceous Gout
2. Evidence of radiographic damage attributable to Gout
3. 2 or more Gout flare per year

Question 11

Classes and names of Urate Lowering Therapy

Answer 11

1. XANTHINE OXIDASE INHIBITORS
   = Reduce production of uric acid

> Allopurinol
Febuxostat

2. URICOSURIC AGENTS
   = Increase the renal clearance of uric acid

> Probenecid

Question 12

Targets for intervention in treatment and prophylaxis of Gout

Diagram

Answer 12

Target to treat approach:
Aim: keep serum urate concentrations <0.36 mmol/L.
Continue urate lowering therapy INDEFINITELY.

Question 13

Allopurinol

Safety and counselling points

Answer 13

Risk of Allopurinol hypersensitivity syndrome is increases in carriers of HLA-B*5801

AVOID!!

Question 14

Fubuxostat

Safety and counselling points

Answer 14

Eligible only if Allopurinol contraindicated/intolerance

Appropriate in HLA-B5801 positive patients

**Risk of cardiovascular death

Question 15

Probenecid

Safety and counselling points

Answer 15

Not recommended in patients with mod to severe CKD
Avoid if crcl <10ml/min

**Risk of drug drug interactions

Question 16

General

COUNSELLING POINTS

Answer 16

1. Gout flares on starting urate lowering therapy is common
   > use anti inflammatory prophylaxis when initiating
2. Don’t stop allopurinol when experiencing acute Gout flares
3. Allopurinol can be stared during an acute attack
4. Serum urate conc should be monitored regularly