Overview
Ask About
- Diagnosis - when gout was diagnosed, joints affected
- Severity - frequency of flares, monoarticular / polyarticular
- Complications - tophi, joint destruction, nephropathy
- Management - during flares, dietary changes, urate-lowering therapy
Risk Factors for Gout
- Male gender
- Obesity
- Chronic kidney disease
- Drugs - diuretics, ethambutol, certain chemotherapeutic agents
- Excess purine-rich foods - beer, shellfish, liver, marmite
- Excess sucrose / fructose intake
- Alcohol excess
Complications
Complications of Gout
- Gouty tophi - in bursae, tendons, subcutaneous tissues
- Joint destruction
- Nephrolithiasis
- Urate nephropathy
Management
Management Options
Acute Management of Flares
- NSAIDs - indomethacin, naproxen, celecoxib
- Colchicine
- Steroids - oral / intra-articular
Non-Pharmacologic
- Weight loss
- Avoidance of risk factors - alcohol, sugar, purine-rich foods
Pharmacologic
- Xanthine oxidase inhibitors - allopurinol, febuxostat
- Uricosurics - probenecid, benzbromarone
Pearls
- The goal for acute management is symptomatic relief
- Don't stop urate-lowering therapy during an acute flare
- Wait until an acute flare resolves completely before starting urate-lowering therapy
- Commencing urate-lowering therapy can precipitate an acute flare of gout!
Next Page
----------------------------------------------------------------------------------------------------------------------------------------------------------------------------