Gout: Difference between revisions
From IDWiki
m (Text replacement - "Clinical Presentation" to "Clinical Manifestations") |
No edit summary |
||
| Line 1: | Line 1: | ||
| − | == |
+ | ==Background== |
| − | * |
+ | *Hyperuricemia leading to arthritis |
| + | ===Pathophysiology=== |
||
| − | == 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 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 |
| − | * |
+ | *[[NSAID|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: [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]] |
||
Latest revision as of 11:21, 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
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
