All::Rheumatology::Diseases::Gout
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What are the main features of gout during acute episodes?
Significant pain, swelling, and erythema, often affecting the 1st metatarsophalangeal (MTP) joint in around 70% of cases.
GoutHow is gout diagnosed, and what uric acid level supports the diagnosis?
Diagnosed by measuring uric acid levels. A uric acid level ≥ 360 umol/L supports the diagnosis during an acute flare.
GoutWhat is the recommended approach if uric acid levels are < 360 umol/L during a suspected gout flare?
Repeat uric acid level measurement at least 2 weeks after the flare has settled if gout is strongly suspected.
GoutWhat is the characteristic appearance of synovial fluid crystals in gout under polarized light?
Needle-shaped, negatively birefringent monosodium urate crystals.
GoutWhat are the radiological features of gout?
Joint effusion, well-defined 'punched-out' erosions with sclerotic margins, eccentric erosions, no periarticular osteopenia, and soft tissue tophi may be seen.
GoutWhat are the first-line options for acute gout management?
NSAIDs or colchicine.
GoutWhy might gastroprotection, such as a proton pump inhibitor, be indicated with NSAID use in gout?
To reduce the risk of gastrointestinal side effects.
GoutWhat is the main side effect of colchicine?
Diarrhoea.
GoutWhen are oral steroids considered in gout management?
Considered if NSAIDs and colchicine are contraindicated; prednisolone 15mg/day is a common dose.
GoutWhat is the primary urate-lowering therapy (ULT) indicated by the British Society of Rheumatology Guidelines?
Allopurinol.
GoutWhy is a delay in starting ULT recommended after an acute gout attack?
To discuss long-term drug decisions when the patient is not in pain.
GoutWhen is a lower initial dose of allopurinol recommended?
For patients with reduced eGFR, and a lower target uric acid level may be considered for those with tophi or ongoing frequent flares.
GoutWhat is the second-line agent for ULT when allopurinol is not tolerated or ineffective?
Febuxostat, also a xanthine oxidase inhibitor.
GoutWhat enzyme catalyzes the conversion of urate to allantoin, and what drug is derived from it for refractory gout?
Uricase (urate oxidase); pegloticase is derived from it for refractory gout.
GoutHow is pegloticase administered for refractory gout?
It is given as an infusion once every two weeks.
GoutWhat lifestyle modifications are recommended for gout management?
Reduce alcohol intake (avoid during acute attacks), lose weight if obese, and avoid high-purine foods like liver, kidneys, seafood, oily fish, and yeast products.
GoutBesides medication, what lifestyle changes can help manage gout?
Stopping precipitating drugs (e.g., thiazides), weight loss, reducing alcohol intake, and avoiding high-purine foods.
GoutHow does losartan contribute to gout management?
Losartan has a specific uricosuric action and may be suitable for hypertensive patients with coexistent gout.
GoutHow can increased vitamin C intake impact serum uric acid levels?
Increased vitamin C intake, either through supplements or a normal diet, may decrease serum uric acid levels.
GoutName some drug causes that can contribute to gout.
Diuretics (thiazides, furosemide), ciclosporin, alcohol, cytotoxic agents, pyrazinamide, and aspirin.
GoutWhat did a systematic review reveal about the relationship between low-dose aspirin and gout attacks?
Low-dose aspirin (e.g., 75mg) increases the risk of gout attacks, even though the cardiovascular benefits need to be considered. Patients coprescribed allopurinol were not at an increased risk.
Gout