Gout

Question 1

What is gout?

Answer 1

• Gout is a common and painful condition due to abormality of uric acid metabolism resulting in high uric acid in blood and urate crystal deposition in the joints
• It can affect the joints (arthritis), soft tissue(tophi and tenosynovitis) and urinary tract(stones)

Question 2

What are the precipitating factors?

Answer 2

• Alcohol excess
• Medications such as frusemide/thiazide diuretics/aspirin
• Sugary soft drinks
• Chronic kidney disease
• Surgical operation
• Overweight or obese

Question 3

What is the aetiology?

Answer 3

• Kidneys not excreting uric acid quick enough out of the body
• More common in men
• It can be acute versus chronic
• Increased purine such as shellfish and meat

Question 4

What are the clinical features?

Answer 4

• Monoarthritis (90%) presentation most common acute presentation
• MTP joint great toe 75%
• Polyarticular more common in older men
• Other common sites are DIP, knees and ankle
• Chronic presentation includes tophi in ears, elbows, fingers and achilles tendon

Question 5

How is gout diagnosed?

Answer 5

• Synovial fluid aspirate for uric acid crystals is diagnostic
• Blood tests are used to rule out joint infections and other forms of arthitis

Question 6

What is asymptomatic hyperuricemia?

Answer 6

• Elevated uric acid with no clinical symptoms
• Does not warrant treatment unless high risk
• 10 times more common than gout

Question 7

How to manage an acute attack of gout?

Answer 7

• NSAIDS such as indomethacin effective in full doses and are first line
• Colchicine effective if used early and avoid in renal impairment
• Corticosteroids injection(after ruling out SA) or oral steroids over 7-10 days if NSAIDS contraindicated
• Avoid aspirin and monito UEC

Question 8

What are the non-pharmacological appeoaches to prevent further attacks?

Answer 8

• Life style emasures such as weight reduction, well balanced diet and avoidance of purine rich food such as shellfish and red meat
• Reduced intake of soft drinks and fluid intake of 2 litres/day
• Reduce ETOH intake
• Avoid diuretics such as thiazides, frusemide and aspirin

Question 9

Can gout be prevented?

Answer 9

• Lifestyle measures
• Aim uric acid levels less than 0.36mmol/litre to avoid attacks
• Allopurinol drug of choice and reduced serum uric acid
• Avoid for 2 weeks after acute attack has settled
• If gout occurs on allopurinol, continue it and treat the acute attack
• Uricosuric agent such as probenecid is used if hypersensitivity to allopurinol
• Untreated gout can cause permanent damage to joints

Question 10

What are the differential diagnosis of acute gout?

Answer 10

• Septic arthritis
• Pseudogout

Question 11

What Ix are needed to address and treat co-morbidities?

Answer 11

• Fasting BSL
• Lipid studies
• BP measurement
• Kidney functions
• Losartan/CCB are uricosuric and beneficial for patients with HTN and gout. Statins are beneficial for lipid control