Gout

Question 1

Define Gout

Answer 1

ACute inflammatory oligoarthropathy due to uric acid crystal deposition in joint space

Predominantly secondary either to overproduction (mailnly obesity)

or Under excretion (renal disease, thiazide diuretics)

Question 2

What are the clinical features?

Answer 2

Gouty tophi - ear pinna and hands

Olecranon bursitis

Oligoarthritis

Often first MCP inflammation - Podagra’

Punched out erosions on x-ray

Question 3

How treat medically?

Answer 3

Acute - NSAIDs or Colchicine if intolerant (cytotuble inhibitor); possibly steroids but may be too painful;

Uric acid levels may be low due to deposition in joint

Chronic - lifestyle change, reduce alcohol, avoid thiazides, control BP

Prevention

• Allopurinol (xanthine oxidase inhibitor), increaseing dose regime - DO NOT start in acute phase; many SE; use febuxostat if can’t take; co-prescribe with colchicine for first 6 weeks
• Uricoscurics - encourage renal excretion e.g. sulfinpyrazone