Gout Flashcards
Gout is characterised by
severe joint pain
swelling
erythema
What is the major risk factor for gout
raised serum urate concentration (hyperuricaemia) which results in the deposition of monosodium rate crystals in and around joints.
I is caused by under excretion of uric acid (90%) where excess rate stores occur due to an inability to excrete sufficient amounts of normally produced uric acid in the urine.
what joints can be affected?
usually big toe first but can affect ankles, wrists, hands and knees too.
How long does an attack last
Initial attacks usually last 3-10 days but later attacks can be prolonged.
Two main causes of gout
under excretion or over production.
Under excretion is caused by renal insufficiency, starvation, dehydration, hypothyroidism, drugs and chronic alcohol especially beer and spirits.
Over production is caused by genetic disorders (e.g. G6PD), high cell turnover (myeloproliferative disorders), psoriasis, chemotherapy,excessive exercise and obesity.
whats percentage of patients with elevated serum uric acid >0.42mmol/L will actually get gout?
5-20%
Treatments for acute attack of gout
1) NSAID - max dose as early as possible and continue 1-2 days after attack has settled.
- Diclofenac 75-150mg in 2-3 divided doses
2) Colchicine - can be used in HF and in pt that can’t take NSAIDS. It causes bad GI side effects. It should be started as quick as possible in an attack. Doses need to be reduced in renal impairment and patients should not take it who use it at maintenance therapy.
Common s/e N & V & D and abode pain. Excess dose can cause bone marrow suppression and renal damage.
- 500mcg 2-4 times a day until symptoms resolve. max 6mg per course. Do not repeat course within 3 days.
Steroids can be used however are not licensed
What do we use for long term management of gout?
Allopurinol - This should be titrated to uric acid levels.
Adverse effects with allopurinol are more common inpatients with renal disease.
100-900mg daily dose dependent on severity. Taken preferably after food.
Gout is becoming less common with newer treatments available true or false.
False
The incidence of gout is increased in lower socioeconomic groups
False
Is gout more common in men or women?
men
What is more common in men,
gout or rheumatoid arthritis?
Rheumatoid arthritis
Gout is rare in women >65 years old T or F
False
Is gout treated well in the UK with urate lowering drugs?
True
Can uric acid levels be normal during an attack?
YEs
