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Flashcards in Gout Deck (11):
1

What are some differentials for a single hot swollen joint?

Gout
Pseudogout
Septic arthritis
Psoriatic arthritis

2

What are the risk factors for gout?

Male
Alcohol intake
High purine intake
Diuretics
BMI
Diabetes
Hypertension

3

What investigations should be done if gout is suspected?

FBC
CRP & ESR
Serum urate
Joint aspiration and synovial fluid analysis - gram stain, culture, microscopy
U&E
LFTs

4

What may be seen on polarising microscopy in gout?

Needle-like crystals of monosodium urate

5

What is the treatment for acute gout?

Fast acting oral NSAIDs at max dose

If renal impairment: colchicine

6

What dose should colchicine be prescribed at?

500 micrograms BD
Avoid adverse effects esp. diarrhoea

7

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
Urolithiasis

2-4 weeks after acute attack has subsided

8

What is the aim of prophylactic gout therapy?

Maintain serum uric acid <300micromoles/L

9

What is used for gout prophylactic therapy?

Allopurinol 100mg daily, titrate every 2-5 weeks
Max dose = 900mg

LIFELONG

CKD 4 start at 50mg daily

10

What are the side effects of allopurinol?

10% patients develop a rash
Allopurinol hypersensitivity syndrome - high mortality

Alternative = febuxostat

11

What should be given alongside initial phase of urate lowering therapy?

Colchicine or low dose NSAID for first 6 months