Gout

Question 1

What causes gout?

Answer 1

Deposition of monosodium urate crystals in joints due to hyperuricaemia.

Question 2

What triggers the inflammation and pain in gout?

Answer 2

The immune system attacks urate crystals deposited in joints.

Question 3

Which joints are most commonly affected by gout?

Answer 3

Distal joints—especially the 1st MTP (toe), knees, ankles, and fingers.

Question 4

What is the primary risk factor for gout?

Answer 4

Hyperuricaemia.

Question 5

Name three dietary factors that increase gout risk.

Answer 5

Alcohol, sugary drinks, red meat, and seafood.

Question 6

List three medical conditions associated with increased gout risk.

Answer 6

CKD, hypertension, diabetes.

Question 7

Which medications are associated with gout?

Answer 7

Diuretics, low-dose aspirin, ciclosporin.

Question 8

What lab test supports a gout diagnosis?

Answer 8

Serum urate ≥360 µmol/L.

Question 9

What is a tophus?

Answer 9

A chalky urate crystal deposit under the skin.

Question 10

What are the first-line treatments for acute gout?

Answer 10

NSAIDs, colchicine, or oral corticosteroids.

Question 11

Why use colchicine with caution?

Answer 11

It has a narrow therapeutic range and risk of toxicity.

Question 12

Can ULT be started during a flare?

Answer 12

Yes, especially if flares are frequent, but generally started after a flare settles.

Question 13

When should urate-lowering therapy (ULT) be offered?

Answer 13

≥2 flares/year, CKD (stage 3–5), on diuretics, presence of tophi or chronic gout.

Question 14

What is the urate level target in chronic gout management?

Answer 14

<360 µmol/L; <300 µmol/L if tophi/chronic symptoms.

Question 15

Name two first-line ULT medications.

Answer 15

Allopurinol and febuxostat.

Question 16

What can be used as prophylaxis during ULT initiation?

Answer 16

Colchicine, low-dose NSAID, or corticosteroid.

Question 17

What is the usual dose of colchicine for acute gout?

Answer 17

500 micrograms 2–4 times a day (maximum 2 mg per day), for up to 3 days.

Question 17

What is the minimum interval between colchicine courses?

Answer 17

At least 3 days (BNF requirement to reduce toxicity risk).

Question 18

What are two key contraindications for colchicine use?

Answer 18

Blood disorders, severe renal/hepatic impairment.

Question 18

What are the main side effects of colchicine?

Answer 18

GI upset (diarrhoea, nausea, vomiting), myopathy, bone marrow suppression (rare).

Question 18

What is a major drug interaction of colchicine?

Answer 18

Strong CYP3A4 or P-gp inhibitors (e.g., clarithromycin, ciclosporin) ↑ risk of toxicity.

Question 19

What is important counselling advice for colchicine?

Answer 19

Stop treatment and seek advice if nausea, vomiting, or diarrhoea occur.

Question 20

What is the mechanism of action of allopurinol?

Answer 20

Xanthine oxidase inhibitor – reduces uric acid production.

Question 21

When should allopurinol be started in gout?

Answer 21

At least 2–4 weeks after a flare has settled (unless frequent flares).

Question 22

What is the main adverse effect to monitor for with allopurinol?

Answer 22

Severe skin rash (can signal Stevens-Johnson Syndrome).

Question 23

Drug class of allopurinol and febuxostat?

Answer 23

Xanthine oxidase inhibitors.

Question 24

Should allopurinol be continued during a gout flare?

Answer 24

Yes – continue and treat the flare separately.

Question 25

What is a key interaction with allopurinol?

Answer 25

Azathioprine or mercaptopurine – risk of severe toxicity (reduce dose significantly or avoid).

Question 26

What is the mechanism of action of febuxostat?

Answer 26

Xanthine oxidase inhibitor – lowers uric acid levels.

Question 27

What is the initial dose of febuxostat?

Answer 27

80 mg once daily, can increase to 120 mg if target urate not achieved.

Question 28

What are the main contraindications for febuxostat?

Answer 28

Ischaemic heart disease, congestive heart failure.

Question 29

What are the common side effects of febuxostat?

Answer 29

Liver function abnormalities, diarrhoea, rash, headache.

Question 30

What is a serious but rare cardiovascular warning with febuxostat?

Answer 30

Risk of cardiovascular death – caution in patients with CVD history.