Gout
From IDWiki
Background
- Hyperuricemia leading to arthritis
Pathophysiology
- Increased uric acid intake or decreased excretion
Risk Factors
- Diet high in meat and seafood
- Alcohol intake
- Chronic kidney disease
- Uric acid kidney stones
- Lymphoproliferative disorders
- Medications
- Thiazides
- Loop diuretics
- Allopurinol (starting or stopping)
Clinical Manifestations
- Hot, red joint with decreased range of motion
- "Bedsheet sign": prefer to keep joint uncovered due to pain
Investigations
- Arthrocentesis
- Elevated white cells with negative Gram stain
- serum uric acid, expected to be high but can be normal during a gout attack
Management
Acute
- Colchicine 1.2mg then 0.6mg an hour later
- NSAIDs
- Prednisone 0.5mg/kg/day for 5-10 days then stop, or for 2-5 days then taper over 7-10 days
Chronic
- Urate-lowering therapy
- First-line: allopurinol 100mg/day (halve it for CKD)
- Titrate up as high as 800mg/day until target serum urate level of 0.35mmol/L achieved (6mg/dL)
- Can start at 50mg/day and titrate up by 50mg/day every two weeks
- Second-line: febuxostat 40mg/day (up to 80mg/d)
- Alternative: probenecid, pegloticase
- Lifestyle changes
- Avoid organ meats, decrease red meat
Further Reading
- 2012 American College of Rheumatology Guidelines for Management of Gout. Part 1: Systematic Nonpharmacologic and Pharmacologic Therapeutic Approaches to Hyperuricemia. Arthritis Care Res. 2012(64)10:1431-1446. doi: 10.1002/acr.21772
- 2012 American College of Rheumatology Guidelines for Management of Gout. Part 2: Therapy and Antiinflammatory Prophylaxis of Acute Gouty Arthritis. Arthritis Care Res. 2012(64)10:1447-1461. doi: 10.1002/acr.21773
