Gout

Question 1

What causes gout?

Answer 1

Hyperuricaemia
Accumulation of uric acid crystals that form in the joints

Question 2

Symptoms of gout

Answer 2

• Sudden severe pain
• Swelling and redness in joints

Question 3

Drugs that cause hyperuricaemia i.e. gout

Answer 3

• Diuretics (Loop + Thiazide)
• Ciclosporin
• Tacrolimus
• Cytotoxic
• Cancer

Question 4

Manament - acute attack

Answer 4

Colchicine or high dose NSAID
Alternative = cortisoteroid

Question 5

NSAID

Answer 5

Diclofenac or Naproxen
Aspirin is NOT indicated in gout.
Continue for 1-2 days after attack has resolved
PPI?

Question 6

Colchicine

Answer 6

Do not repeat course in 3 days
Max dose = 500 mcg 2-4 times a day
Max 6 mg per course

Question 7

Corticosteroids

Answer 7

Off-labeL use
Short course (3-5 days)
30 - 35 mg OD

Question 8

Management - prevention

Answer 8

Xanthane oxidase inhibitors
1st line = Allopurinol
2nd line = Febuxostat

Question 9

Febuxostat - side effects

Answer 9

• Serious hypersensitivity reactions
• Anaphylaxis
• SJS
• Check liver function
• Caution in pre-existing CVD (allopurinol is the drug of choice)

Question 10

Uricosuric drugs

Answer 10

Sulfinapyrazone
Side effects:
- Makes urine alkaline
- Allows urea crystals to form
- Ensure adequate renal function/urine output

Question 11

Important points

Answer 11

Never star during an acute attack
- Start preventative treatment 2-4 weeks after acute attack has resolved.
- If acute attacks are more common, may start earlier/during.

Initiation may precipitate an acute attack
- Use NSAID/Colchicine for 1 month after hyperuricaemia corrected

If an attack occurs during prophylaxis
- Continue as normal
- Treat attack separately

Question 12

Allopurinol

Answer 12

1st line in prophylaxis of gout
SE = rash
- If mild, reintroduce. Stop if occurs again
Take with or after food

Question 13

Allopurinol - interactions

Answer 13

Reduce dose of azathioprine/mercaptopurine by 1/4 to 1/2 with allopurinol
- Increased risk of toxicity