Gout: Difference between revisions

Latest revision as of 15:21, 29 July 2020

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

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

@@ 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 Presentation ==
+==Clinical Manifestations==
-* Hot, red joint with decreased range of motion
+*Hot, red joint with decreased range of motion
-* &quot;Bedsheet sign&quot;: prefer to keep joint uncovered due to pain
+*&quot;Bedsheet sign&quot;: 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]]