Gout Flashcards
What crystals are deposited in gout?
Monosodium urate
Calcium pyrophosphate in Pseudogout.
What are some drugs that can cause gout?
- thiazides, furosemide
- alcohol
- cytotoxic agents
- pyrazinamide
What, in the blood, leads to gout & what level of it is considered indicative for having gout?
Hyperuricaemia
Uric Acid >450 mol/l
What is the acute management strategy for Gout?
- NSAIDs are now first line + PPI Cover- naproxen or indomethacin.
-
Colchicine is second line - Colchicine has a slower onset of action.
- The main side-effect is diarrhoea.
- 500mcg 2 to 4 times daily until the attack resolves.
- Low dose just as effective as high but with fewer S/E.
- Intra-articular steroid injection
-
Oral steroids may be considered if NSAIDs and colchicine are contraindicated.
- A dose of Prednisolone 0.5mg/kg per day for 5 to 10 days.
- Caferul if diabetic as can adversely effect diabetic control.
- If the patient is already taking allopurinol it should be continued
- Review 4-6 weeks.
After an attack of gout, what should your follow up plan be?
- Serum uric acid levels are checked 4-6 weeks after the acute attack.
- Measure BP, fasting glucose, renal function and lipid profile & treat if abnormal.
- Advice on risk factors.
- Consider prophylactic medication if a person is having 2 or more attacks in 1 year.
- Consider providing adanced prescriptions if future attacks.
What are some drugs that colchicine interacts with?
- Amiodarone
- Digoxin
- Statins
- certain CCBs - increase uric acid levels
What is Podagra?
Inflammation of the first metatarsophalangeal joint.
How quickly does gout resolve if untreated?
5 to 15 days
What can be seen in the ears and elbows?
Tophi
When should colchicine not be given?
In severe renal failure
eGFR 10-50 reduce dose
If <10 do not give.
If a patient is on Aspirin and gets an epiode of gout, should it be switched?
No, continue Aspirin. It has no effect on Gout.
When is allopurinol indicated?
- ≥ 2 attacks per year
- High levels of Uric Acid (>600 micromol/L)
- Gouty tophi
- Past urolithiasis
- CKD
- Joint damage
- Ongoing required diuretic usage
What is your urate lowering therapy strategy?
- Allopurinol should not be started until 2 weeks after an acute attack has settled (At 4-6 week check up) as it may precipitate a further attack if started too early
- Initial dose of 100 mg od, with the dose titrated every few weeks to a daily maximum of 900mg.
- Aim for a serum uric acid of < 360 µmol/l
- NSAID+PPI or Colchicine (500mcg for 6 weeks) cover should be used when starting allopurinol.
What can be used if allopurinol doesnt work?
Febuxostat
A newer xanthine oxidase inhibitor,
approved by NICE if allopurinol not tolerated
What lifestyle advice can be given to help reduce occurences of gout?
- Aim for an ideal body weight — but avoid crash dieting and high protein/low carbohydrate diets.
- Eat sensibly — by restricting the amount of red meat and avoiding a high protein intake. Avoid excessive consumption of foods rich in purines (such as liver, kidneys, and seafood).
- Drink alcohol sensibly — by avoiding binge drinking and restricting alcohol consumption to 4 units per week for men and 14 units per week for women, with at least two alcohol-free days a week.
- Avoid dehydration by drinking water (up to 2 litres/day unless there is a medical contraindication).
- Drink skimmed milk or consume low-fat dairy products (up to 2 servings daily).
- Limit consumption of sugary drinks and snacks.
- Take regular exercise — but avoid intense muscular exercise and trauma to joints.
- Stop smoking
- Consider taking vitamin C supplements.
What A2Rb has uricosuric actions and can be useful in recurrent Gout?
Losartan
If someone is taking Allopurinol and they have another attack of Gout, what should be done with it?
It should be continued.
