Gout: Introduction FeedbackA general introduction to Gout.Source: Clinical Knowledge Summaries, 01 Aug 2012
Gout is a 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.
The natural history of gout can occur in three distinct phases:
A long period of asymptomatic hyperuricaemia.
A period during which acute attacks of gouty arthritis are followed by variable intervals (months to years) when there are no symptoms.
The final period of chronic tophaceous gout where people have nodules affecting joints.
Hyperuricaemia is the single most important risk factor for developing gout.
Gout is more common in men and in older people. Only 3–6% of people with gout have onset of the disease before 25 years of age.
Hyperuricaemia-induced renal disease is a possible complication of gout. Also, tophi may become inflamed, exude tophaceous material, or develop secondary infection.
First acute attacks of gout usually completely subside in 3–10 days. However, attacks may recur.
The diagnosis of gout is based on the clinical history and examination. There is no single examination which confirms a diagnosis of gout.
To manage an acute attack of gout:
A nonsteroidal anti-inflammatory drug (NSAID) e.g. diclofenac, should be prescribed as soon as possible and continued until 48 hours after the attack has resolved (a proton pump inhibitor or misoprostol can be co-prescribed for gastric protection, if necessary).
If NSAIDs are unsuitable, colchicine is an option.
If colchicine is unsuitable, systemic corticosteroids can be considered.
Paracetamol (with or without codeine) should be used if NSAIDs, colchicine, and corticosteroids are all unsuitable.
Appropriate self-care advice should be given (e.g. rest and keeping the joint in a cool environment by avoiding clothing and using an ice pack).
Appropriate life-style advice should be provided (e.g. weight loss and smoking cessation).
If there is no improvement in symptoms after 2–3 days:
The diagnosis should be reviewed.
Compliance with medications and self-care strategies should be checked.
Medication can be increased to the maximum dose.
To prevent an attack of gout:
Allopurinol should be prescribed — after two or more attacks of gout within a year or after the first attack in people at higher risk with one or more tophi, X-ray features of gouty arthritis, renal impairment, known uric acid stones, or on long-term diuretic medication.
Febuxostat can be considered as second-line therapy if allopurinol is not tolerated or contraindicated.
Co-prescription of a low dose of an NSAID or low-dose colchicine may prevent acute attacks of gout during urate lowering treatment with allopurinol or febuxostat.
Allopurinol or febuxostat should be started 1-2 weeks after the inflammation has settled, as the drug may precipitate further attacks.
Advice should be sought from a specialist if:
The diagnosis is uncertain.
Gout occurs during pregnancy or in a person under 25 years of age.
Complications are present.
The person is at risk of adverse effects of drug treatment.
Gout: Guidance FeedbackThe most relevant search results for Gout from producers of guidance information.
Information for the public
Gout: Information for the public FeedbackThe most relevant search results for Gout, from Department of Health accredited producers of patient information.
Gout: Medicines FeedbackAppropriate medicines information for Gout supplied by Datapharm, a leading source of trusted, credible information about medicines.
Gout - Medicines Information
- Adenuric (a brand of Febuxostat)
- Diclofenac potassium
- Diclofenac sodium
- Dicloflex (a brand of Diclofenac Sodium)
- Diclomax (a brand of Diclofenac Sodium)
- Econac (a brand of Diclofenac Sodium)
- Etoricoxib (a generic version of Arcoxia)
- Ketocid (a brand of Ketoprofen)
- Ketovail (a brand of Ketoprofen)
- Motifene (a brand of Diclofenac Sodium)
- Orudis (a brand of Ketoprofen)
- Oruvail (a brand of Ketoprofen)
- Voltarol (a brand of Diclofenac Sodium)
- Voltarol Dispersible (a brand of Diclofenac Sodium)
- Voltarol Rapid (a brand of Diclofenac Potassium)
- Zyloric (a brand of Allopurinol)
- Results are currently sorted by relevance (Sort results by: date)
- Results 1 - 10 (of 148)
...bone. Crystal deposition — principally gout or, rarely, pseudogout. Systemic disease...on Baker's cyst, Cellulitis - acute, Gout, Greater trochanteric pain syndrome... Crystal deposition — principally gout or, rarely, pseudogout [Wasserman et...
Clinical Knowledge Summaries, 01 November 2010
...Managing any associated conditions, such as gout, cellulitis, or rheumatoid arthritis...sites. There are separate CKS topics on Gout, Greater trochanteric pain syndrome... Systemic conditions — most commonly gout or rheumatoid arthritis (intra-bursal...
Clinical Knowledge Summaries, 11 October 2010
...Necrotizing fasciitis. Gangrene. Acute gout. Adverse drug reactions. Metastatic...topic on Deep vein thrombosis. Acute gout — swelling, redness, warmth, and pain...skin around the joint may be inflamed (gout cellulitis). For more information see...
Clinical Knowledge Summaries, 01 September 2012
...disease, atrial fibrillation, diabetes, gout, and renal impairment. Scenario...Atrial fibrillation . Diabetes . Gout . Renal impairment . Basis for recommendation...chronic obstructive pulmonary disease. Gout. Valve disease. Basis for recommendation...
Clinical Knowledge Summaries, 29 November 2010
...Diuretics are best avoided in people with gout — they can cause hyperuricaemia (increased serum uric acid levels) and gout. If a thiazide-type diuretic is necessary...with allopurinol. See the CKS topic on Gout. Thiazide-type diuretics should...
Clinical Knowledge Summaries, 01 April 2012
...suitable for people with aspirin allergy, renal insufficiency, gout, or who are taking an anticoagulant such as warfarin, as well...suitable for people with aspirin allergy, renal insufficiency, gout, or those taking anticoagulants [Hill and Ryan, 2008; CDC...
Clinical Knowledge Summaries, 01 May 2013
...diuretics are best avoided in people with gout, as they may cause hyperuricaemia (increased serum uric acid levels) and gout. If a thiazide-type diuretic is necessary...with allopurinol. See the CKS topic on Gout. Adverse effects What are the...
Clinical Knowledge Summaries, 01 July 2010
Simple (or non-specific) neck pain is neck pain for which no specific cause can be found.The cause is usually multifactorial and includes poor posture, neck strain, sporting and occupational activities, anxiety, and depression.Diagnosis of a person
Clinical Knowledge Summaries, 01 September 2013
Migraine is a primary episodic headache disorder. It is characterized by episodic severe headaches with associated symptoms such as photophobia, phonophobia, and nausea and vomiting. The most common subtypes of migraine are migraine without aura and
Clinical Knowledge Summaries, 01 August 2013
A urinary tract infection (UTI) is usually caused by bacteria from the gastrointestinal tract, most commonly Escherichia coli.Acute, uncomplicated UTI is a benign condition that usually resolves in a few days.Ascending infection can occur, leading
Clinical Knowledge Summaries, 01 November 2013
Searches related to “Gout”
- BNF/BNFc sections
- Areas of interest
Types of information
Select one or more of the 'type of information' options below to narrow your search
Start typing a Source name to narrow your search, or select one or more from the list
- British National Formulary - BNF (9)
- British National Formulary for Children - BNFc (9)
- Clinical Knowledge Summaries - CKS (28)
- Cochrane Database of Systematic Reviews (8)
- electronic Medicines Compendium - eMC (38)
- Healthtalkonline (14)
- Medicines and Healthcare products Regulatory Agency - MHRA(3)
- National Institute for Health and Care Excellence - NICE (2)
- NHS England(3)
- NIHR Journals Library - Health Technology Assessment(16)
- NIHR Journals Library - Programme Grants for Applied Research(1)
- Patient UK(3)
- Royal College of Anaesthetists (2)
- Scottish Intercollegiate Guidelines Network - SIGN (2)
- WHO Regional Office for Europe - WHO Europe (1)
Medicines and devices
Start typing a Medicine or device name to narrow your search, or select one or more from the A-Z list
- Certolizumab pegol(57)
- Diclofenac potassium(37)
- Diclofenac sodium(84)
- Folic acid(32)
- Glyceryl trinitrate(17)
- Influenza vaccine(33)
- Irbesartan + hydrochlorothiazide(16)
- Losartan + hydrochlorothiazide(16)
- Mefenamic acid(51)
- Mycophenolate mofetil(70)
- Nalidixic acid(17)
- Paracetamol + ibuprofen(25)
- Peginterferon alfa-2b(20)
- Potassium canrenoate(63)
- Propylene glycol(32)
- Sodium chloride(32)
- Sodium lactate(18)
- Sodium nitroprusside(110)
- Tiaprofenic acid(25)
- Tolfenamic acid(17)
- Triamcinolone acetonide(21)
- Valsartan + hydrochlorothiazide(22)
- Clear all filters