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.
