Gout

Data gathering

  • Red flags – fever, nausea/vomiting, kidney problems
  • Others – diet, alcohol, medications, dehydration
  • Examine – pulse, BP, BMI, feet

 

Clinical management

  • Investigations
    • Bloods – FBC, U+Es, HbA1c, lipids, uric acid (4 weeks after attack)
  • Explanation
    • Build-up of uric acid crystals in the joint
  • Treatment
    • Acute
      • RICE
      • NSAIDs or Colchicine (500micrograms QDS max 3 days i.e. 6mg total course) or oral steroids
    • Prophylaxis
      • Lifestyle – reduce weight, reduce alcohol, hydration, gout diet (less red meat, liver, seafood)
      • Allopurinol
        • if 2 attacks in one year or first if renal impairment/tophi/long term diuretics
        • start at least 2 weeks after attack
        • cover with NSAID
        • titrate until uric acid < 300
  • Followup / Safety-net