Gout

Question 1

Symptoms

Answer 1

• Joint pain
• Sudden intense, swollen
• Purple red shiny skin
• Tophi

Question 2

Drugs that cause/worsens hyperuricemia

Answer 2

• Loop + thiazide diuretic
• Cytotoxic drug
• Ciclosporin + tacrolimus

Question 3

Drugs

Answer 3

• NSAID (fluid retention)
• Colchicine (narrow therapeutic drug)

Xanthine oxidase inhibitors
- Allopurinol
- Febuxostat

Uricosuric drugs
- Sulfinpyrazone (if good renal function, uric acid crystals in urine)

Question 4

Treatment: acute

Answer 4

High dose NSAID OR
- Aspirin not indicated

Colchicine OR
- Max dose: 500mcg BD - QDS
- Max 6mg/course
- No repeat course in 3 days

Oral corticosteroids
- Short course

Question 5

Treatment: prevention

Answer 5

First line: allopurinol OR
- May precipitate acute attack
- Never start during acute attack
- Treat attacks separately - If acute attacks happen during prevention, continue as normal

Febuxostat
- MHRA: Serious hypersensitivity (anaphylaxis + SJS)
- Counsel: stop + report signs + symptoms
- MHRA: febuxostat, caution: CVD

Question 6

Allopurinol: MOA

Answer 6

Xanthine oxidase inhibitor prevents the formation of uric acid

Label: take with or just after food or a meal, take with a full glass of water

Question 7

Allopurinol: indication

Answer 7

First line: gout prevention

Question 8

Allopurinol: side effect

Answer 8

Rashes (stop if mild, re-introduce slowly - stop if reoccurs)

Question 9

Allopurinol: interaction

Answer 9

Azathioprine + mercaptopurine toxicity = RED dose