Gout

Gout

An inflammation of joint/s affecting mostly adult males

Causes:

• Altered urate metabolism with deposition of urate salts in the joint and other tissues in

advanced cases

Clinical features

• Attacks mostly the big toe at the metatarsophalangeal joint (podagra), occasionally may

   start in other joints

• Sudden severe pain (often at night)

• Increase in local heat

• Swelling, effusion (if knee joint)

• Usually no fever

• Lumps under the skin (tophi) in soft tissues, eg. the ear

Differential diagnosis

• Joint infection

• Rheumatoid arthritis

• Injury

Investigations

X−ray: of the joint/s

Blood: serum uric acid (elevated)

Management

Acute attacks:

Aspirate the joint (large joints)

Rest the joint

Control the diet

indomethacin 50mg every 4−6 hours for 24−48 hours then 25−50mg every 8 hours for the

duration of the attack

or diclofenac 25−50mg every 8 hours after food

or colchicine 1mg initially then 500 micrograms every 2−3 hours until relief is obtained or

vomiting and diarrhoea occurs or until total dose of 6mg is reached

− do not repeat course within 3 days

Chronic gout:

allopurinol initially 100mg daily after food then increase by 100mg weekly according to

plasma or urinary uric acid levels to daily maintenance dose of 100−900mg depending on the

severity of the condition

− average dose: 300mg daily

− give daily doses totalling >300mg in divided doses

Note

Allopurinol: do not use for treating acute attacks of gout or for treating asymptomatic

hyperuricaemia and do not start the drug within 1 month of an acute attack

• Start prophylactic colchicine 500 micrograms every 12 hours 2−3 days before starting

allopurinol and continue for at least 1 month after the hyperuricaemia has been corrected

(usually about 3 months therapy is required)

• If an acute attack starts during treatment of chronic gout, treat this in its own right while

continuing the therapy for the chronic condition

Prevention

• Avoid eating red meat − especially if roasted

• Avoid drinking alcohol

• Weight reduction