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Gout:disorder of purine metabolism characterized by a raised uric acid…
Gout:disorder of purine metabolism characterized by a raised uric acid level in the blood (hyperuricaemia) and the deposition of urate crystals in joints and other tissues.
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Differentials
Bursitis, cellulitis, tenosynovitis.
Non-urate crystal-induced arthropathy, such as pseudogout
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Assessment
Possible risk factors - alcohol intake, diet, use of drugs, FHx, Associated comorbidity, more common in men
PMHx arthritis or Trophi (firm, white nodules under translucent skin)
Age of onset- gout in <30 suggests renal or enzymatic disorder. Elderly presents atypically with an insidious onset and polyarticular involvement. Post menopausal women presents in hand small joint tophi
Current and previous attacks - site, symptoms, frequency of attacks, treatment used,affect on mobility
Management
Acute attack
Self care: rest and elevate limb, avoid trauma, expose joint to cool environment, ice pack or bed cage. Lifestyle advice- weight loss, alcohol consumption, fluid intake
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if NSAIDS contraindicated -oral colchicine- 500mcg two to four times a day, until pain relief is achieved or D&V occurs. Do not exceed a total dose of 6 mg of colchicine (i.e. up to 6 days with colchicine 500 micrograms twice a day, or up to 3 days with colchicine 500 micrograms four times a day), and
Do not repeat treatment within three days.
elderly or people with an eGFR of 10-50 mL/minute/1.73m2 use a reduced dose or increase the dosage interval. Colchicine is contraindicated in people with an eGFR less than 10 mL/minute/1.72m2.
If NSAIDs or colchicine not tolerated a short course of oral corticosteroids can be given or consider IM corticosteroid injection
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Do not stop allopurinol or febuxostat during an acute attack of gout if the person is already established on these drugs
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Prevention
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1st Line Allopurinol 2nd Line Febuxostat, usually life long
Primary prevention of gout, tophi, cardiovascular disease or renal disease with ULT in people with asymptomatic hyperuricaemia is not recommended although lifestyle advice can be considered.
acute attacks and tophi has resolved and serum urate levels between 300-360micromol/l following review, treatment could be stopped if increased CVS or renal risk
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