Gout Flashcards
Gout
M > F
highest prevenalance in maori and Pacific islanders
Biggest risk factors:
-metabolic syndrome
-medications (diuretics and ciclosporin)
-CKD
diet has little effect of uric acid levels
BUT high purine foods are known to increase flares
Even if severe hyperuricaemia (>0.6) les than half develop gout over next 15years
Presentation typicaly quick onset within 12 hours and often settles within 1-2 weeks
Diagnosis:
1) synovial fluid polarised light microscopy (negative birefrigence)
bloods not diagnostic as urate can be normal during flare
2) USS or Dual energy CT
Management:
-modify risk factors (HTN, dyslipidaemia, DM, CKD)
-minimal emphasis on dietary adjustment and weight loss
-medications:
*if frequent flares need urate lowering therapy
Acute
-colchicine 500mcg BD (reduce dose if diarrhoea), monitor renal function, CK, CBE
or NSAIDs or prednisolone (intrarticular if possible, <20mg daily if oral)
Chronic
*with colchicine 500mcg daily ofr 3-6months to reduce flares
1) Allopurinol
-escalate 100mg per month to 900mg max
-NOT in HLA-B*5801 (SE Asian and African populations)
-if skin rash must cease and review for allopurinol hypersensitivity syndrome
2) Febuxostat
-40mg per month to 120mg
-caution if CVD, PAD, DM history
3) Probenacid
-250mg BD increase monthly to 250-500mg to max 2g daily
-contraindicated if renal stones or eGFR <30ml/L
Adjuncts-moderate urate lowering effects of:
-fenofibrate
-lorsartan
-SGLT2i
