Gout

Question 1

Pharmacological Management of Acute Gout Attack

Answer 1

• Local Triamcinolone acetonide Injection
• NSAID (Diclofenac 50mg PO TDS x 5 days)
• Prednisolone 15-30mg PO OD x 3-5 days
• 2nd - Colchicine 1mg PO -> 500microg PO 1 hour later.

Avoid Thiazide and loop diuretics
Consider avoiding fenofibrate, losartan, Aspirin.

Question 2

Non-pharmacological advice for Gout

Answer 2

• Limit alcohol intake to < 2std drinks per day
• Reduction in Purine in diet
• Reduction in fructose containing beverages
• Regular moderate intensity exercise of 150mins/week
• Drink water with aim for urine to be clear
• Maintain BMI 18-25

Question 3

Pharmacological Gout Prophylaxis

Answer 3

Allopurinol 50mg PO OD x 4weeks then up-titrate up to max 900mg based upon uric acid levels

Uric acid level tagets
- Gout without tophi 0.36
- Gout with tophi 0.30

Flare Prophylaxis
1st Colchicine 500microg PO OD/BD
2nd - NSAID
3rd - Prednisolone 5mg PO OD.
Consider for at least 6 months (or no flares whilst on allopurinol with target uric acid level achieved)

Flare occured? Cease Allopurinol and restart when flare over.