Gout - Revision history

Aidan at 15:21, 29 July 2020

2020-07-29T15:21:03Z

← Older revision		Revision as of 15:21, 29 July 2020
Line 1:		Line 1:
	== ~~Definition~~ ==		==Background==

	* Hyperuricemia leading to arthritis		*Hyperuricemia leading to arthritis

			===Pathophysiology===
	== Etiology ==

	* Increased uric acid intake or decreased excretion		*Increased uric acid intake or decreased excretion

	== Risk Factors ==		===Risk Factors===

	* Diet high in meat and seafood		*Diet high in meat and seafood
	* Alcohol intake		*Alcohol intake
	* Chronic kidney disease		*Chronic kidney disease
	* Uric acid kidney stones		*Uric acid kidney stones
	* Lymphoproliferative disorders		*Lymphoproliferative disorders
	* Medications		*Medications
	** Thiazides		**Thiazides
	** Loop diuretics		**Loop diuretics
	** Allopurinol (starting or stopping)		**Allopurinol (starting or stopping)

	== Clinical Manifestations ==		==Clinical Manifestations==

	* Hot, red joint with decreased range of motion		*Hot, red joint with decreased range of motion
	* "Bedsheet sign": prefer to keep joint uncovered due to pain		*"Bedsheet sign": prefer to keep joint uncovered due to pain

	== Investigations ==		==Investigations==

	* Arthrocentesis		*Arthrocentesis
	** ~~White~~ cells with negative Gram stain		**Elevated white cells with negative Gram stain
	* ~~Uric~~ acid, expected to be high but can be normal during a gout attack		*serum uric acid, expected to be high but can be normal during a gout attack

	== Management ==		==Management==

	=== Acute ===		===Acute===

	* Colchicine 1.2mg then 0.6mg an hour later		*[[Colchicine]] 1.2mg then 0.6mg an hour later
	* NSAIDs		*[[NSAID\|NSAIDs]]
	* Prednisone 0.5mg/kg/day for 5-10 days then stop, or for 2-5 days then taper over 7-10 days		*[[Prednisone]] 0.5mg/kg/day for 5-10 days then stop, or for 2-5 days then taper over 7-10 days

	=== Chronic ===		===Chronic===

	* Urate-lowering therapy		*Urate-lowering therapy
	* First-line: allopurinol 100mg/day (halve it for CKD)		*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)		**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		**Can start at 50mg/day and titrate up by 50mg/day every two weeks
	* Second-line: febuxostat 40mg/day (up to 80mg/d)		*Second-line: [[febuxostat]] 40mg/day (up to 80mg/d)
	* Alternative: probenecid, pegloticase		*Alternative: [[probenecid]], [[pegloticase]]
	* Lifestyle changes		*Lifestyle changes
	** Avoid organ meats, decrease red meat		**Avoid organ meats, decrease red meat

	== Further Reading ==		==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: [https://doi.org/10.1002/acr.21772 10.1002/acr.21772]
	* ACR Guidelines for the Management of Gout, [https://www.rheumatology.org/Portals/0/Files/ACR%20Guidelines%20for%20Management%20of%20Gout_Part%201.pdf Part 1] and [https://www.rheumatology.org/Portals/0/Files/ACR%20Guidelines%20for%20Management%20of%20Gout_Part%202.pdf Part 2]
			*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: [https://doi.org/10.1002/acr.21773 10.1002/acr.21773]

	[[Category:Rheumatology]]		[[Category:Rheumatology]]

Aidan: Text replacement - "Clinical Presentation" to "Clinical Manifestations"

2020-07-19T12:22:56Z

Text replacement - "Clinical Presentation" to "Clinical Manifestations"

← Older revision		Revision as of 12:22, 19 July 2020
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	** Allopurinol (starting or stopping)		** Allopurinol (starting or stopping)

	== Clinical ~~Presentation~~ ==		== Clinical Manifestations ==

	* Hot, red joint with decreased range of motion		* Hot, red joint with decreased range of motion

Maintenance script: Imported from text file

2020-07-04T01:17:36Z

Imported from text file

New page

== Definition ==

* Hyperuricemia leading to arthritis

== Etiology ==

* 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 Presentation ==

* Hot, red joint with decreased range of motion
* "Bedsheet sign": prefer to keep joint uncovered due to pain

== Investigations ==

* Arthrocentesis
** White cells with negative Gram stain
* 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 ==

* ACR Guidelines for the Management of Gout, [https://www.rheumatology.org/Portals/0/Files/ACR%20Guidelines%20for%20Management%20of%20Gout_Part%201.pdf Part 1] and [https://www.rheumatology.org/Portals/0/Files/ACR%20Guidelines%20for%20Management%20of%20Gout_Part%202.pdf Part 2]

[[Category:Rheumatology]]