• Acute & Chronic Gout

    by  • 29/06/2013 • Rheumatology

    Acute gout

    1. Intermittent attacks of acute joint pain due to uric acid crystal accumulation, 3-8/1000, inc with age, men.
    2. RFs: FH, obesity, excess alcohol, high purine diet, diuretics, acute infection, ketosis, surgery, psoriasis, polycythaemia, leukaemia, cytotoxics, renal failure.
    3. p/c: acute painful swollen joint (big toe), red peeling skin, fever, can be polyarticular in elderly. Rule out septic arthritis.
    4. Ix: raised WCC, raised ESR, high blood urate, do microscopy of synovial fluid (=sodium mononitrate crystals on light microscopy).
    5. Mx: exclude infection, rest and elevate, ice, NSAIDs (diclofenac 75mg), colchicine 500mg, steroid injection, or depomedrone 80-120mg IM.
    6. Prophylaxis:
    7. Lose weight, avoid purines (red meat, yeast, mussles)/alcohol, avoid diuretics/aspirin, allopurinol 100-300mg OD then 1/12 later prescribe colchicine/NSAIDs. Check serum urate levels after 2/12. Or try probenicid 250-500mg bd. 

    Chronic gout

    1. Recurrent attcaks, tophi in pinna/tendons/joints. Refer to rheum. 
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