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Gout

 
 
 
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Overview

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  • 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!
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