Flashcards in Gout Deck (11):
What are some differentials for a single hot swollen joint?
What are the risk factors for gout?
High purine intake
What investigations should be done if gout is suspected?
CRP & ESR
Joint aspiration and synovial fluid analysis - gram stain, culture, microscopy
What may be seen on polarising microscopy in gout?
Needle-like crystals of monosodium urate
What is the treatment for acute gout?
Fast acting oral NSAIDs at max dose
If renal impairment: colchicine
What dose should colchicine be prescribed at?
500 micrograms BD
Avoid adverse effects esp. diarrhoea
When should prophylactic gout treatment be initiated?
Two or more attacks of acute gout per year
Tophus or tophi on imaging
CKD stage II or worse
2-4 weeks after acute attack has subsided
What is the aim of prophylactic gout therapy?
Maintain serum uric acid <300micromoles/L
What is used for gout prophylactic therapy?
Allopurinol 100mg daily, titrate every 2-5 weeks
Max dose = 900mg
CKD 4 start at 50mg daily
What are the side effects of allopurinol?
10% patients develop a rash
Allopurinol hypersensitivity syndrome - high mortality
Alternative = febuxostat