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.
- Bupa , 16 January 2014
- NHS Choices, 20 March 2012
TA291 Gout (tophaceous, severe debilitating, chronic) - pegloticase: information for the public [PDF]National Institute for Health and Care Excellence, 26 June 2013
- Patient UK
- Patient UK
- NHS Choices, 09 May 2013
Gout: Ongoing Research FeedbackThe most relevant search results for Gout, from research trials.
Gout: Evidence Uncertainty FeedbackThe most relevant search results for Gout, highlighting areas where further research is needed.
- UK Database of Uncertainties about the Effects of Treatments, 03 June 2013
- UK Database of Uncertainties about the Effects of Treatments, 02 May 2013
- UK Database of Uncertainties about the Effects of Treatments, 09 December 2013
- UK Database of Uncertainties about the Effects of Treatments, 16 November 2012
- UK Database of Uncertainties about the Effects of Treatments, 02 May 2013
- UK Database of Uncertainties about the Effects of Treatments, 18 January 2010
- UK Database of Uncertainties about the Effects of Treatments, 20 November 2012
- UK Database of Uncertainties about the Effects of Treatments, 24 September 2012
- UK Database of Uncertainties about the Effects of Treatments, 20 July 2012
- UK Database of Uncertainties about the Effects of Treatments, 23 October 2012
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)
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...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
...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
Chapters Monographs Interactions Preparations April 2014 Home What's changed A to Zs Home > A1 Interactions > List of drug interactions Cytotoxics Cytotoxics has the following interaction information: Clozapine avoid concomitant use of cytotoxics
British National Formulary, 07 April 2014
- Alkylating Drugs
- Antibiotics (cytotoxic)
- Arsenic Trioxide
- Brentuximab vedotin
- Platinum Compounds
- Protein Kinase Inhibitors
...is still used in the acute treatment of gout . Diclofenac has been highlighted...commonly recommended in the treatment of gout, but there appear to be no good reasons...indomethacin 50 mg three times daily in acute gout: a randomized controlled trial. Arthritis...
28 September 2011 - Publisher: PLoS Medicine - Publication type: News - News
Aspirin, steroidal and non-steroidal anti-inflammatory drugs for the treatment of Alzheimer's disease
BackgroundAlzheimers disease (AD) is the most common form of dementia. The incidence of AD rises exponentially with age and its prevalence will increase significantly worldwide in the next few decades. Inflammatory processes have been suspected in
Cochrane Database of Systematic Reviews, 15 February 2012 - Publisher: John Wiley & Sons, Ltd
BackgroundDysmenorrhoea is a common gynaecological problem consisting of painful cramps accompanying menstruation, which in the absence of any underlying abnormality is known as primary dysmenorrhoea. Research has shown that women with dysmenorrhoea
Cochrane Database of Systematic Reviews, 20 January 2010 - Publisher: John Wiley & Sons, Ltd
...infections) aspirin (for pain, fever or to prevent blood clots) quinidine (to treat arrhythmias) colchicine (for gout) immunosupressants such as ciclosporin, sirolimus, everolimus and tacrolimus (to prevent organ transplant rejection...
electronic Medicines Compendium, 14 January 2011 - Publisher: X-PIL, Datapharm Communications Ltd - Publication type: Alternative format Patient Information Leaflet
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