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.
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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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Scottish Intercollegiate Guidelines Network, 01 November 2008
...any of these treatments. 4.11 HEaRT faIlURE aND GOUT Loop diuretics can cause an elevated urate level and may precipitate gout.90 No evidence was identified on how best to treat gout in patients with heart failure. Current practice in...
Scottish Intercollegiate Guidelines Network, 01 February 2007
Medicines and Healthcare products Regulatory Agency, 01 October 2007
Medicines and Healthcare products Regulatory Agency, 07 May 2008
BackgroundAnimal models of traumatic brain injury suggest that induced normothermia (36.5 or 37 ºC), compared to induced hyperthermia (39 ºC), improves histopathological and neurobehavioural outcomes. Observational clinical studies of patients with
Cochrane Database of Systematic Reviews, 19 August 2014 - Publisher: John Wiley & Sons, Ltd
BackgroundAmyotrophic lateral sclerosis (ALS), also known as motor neuron disease (MND), is the most common neurodegenerative disorder of the motor system in adults. Pain in ALS is a frequent symptom especially in the later stages of disease and can
Cochrane Database of Systematic Reviews, 05 June 2013 - Publisher: John Wiley & Sons, Ltd
BackgroundNon-steroidal anti-inflammatory drugs (NSAIDs) have been widely used for the treatment of pain and fever associated with the common cold. However, there is no systematic review to assess the effects of NSAIDs in treating the common
Cochrane Database of Systematic Reviews, 04 June 2013 - Publisher: John Wiley & Sons, Ltd
BackgroundPain in rheumatoid arthritis is common, is often multi-factorial and many different pharmacotherapeutic agents are routinely used for pain management. There are concerns that some of the pain pharmacotherapies currently used may increase
Cochrane Database of Systematic Reviews, 05 October 2011 - Publisher: John Wiley & Sons, Ltd
Safety of non-steroidal anti-inflammatory drugs, including aspirin and paracetamol (acetaminophen) in people receiving methotrexate for inflammatory arthritis (rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis, other spondyloarthritis)
BackgroundMethotrexate is routinely used in the treatment of inflammatory arthritis. There have been concerns regarding the safety of using concurrent non-steroidal anti-inflammatory drugs (NSAIDs), including aspirin, or paracetamol (acetaminophen),
Cochrane Database of Systematic Reviews, 09 November 2011 - Publisher: John Wiley & Sons, Ltd
BackgroundThirty-five Cochrane Reviews of randomised trials testing the analgesic efficacy of individual drug interventions in acute postoperative pain have been published. This overview brings together the results of all those reviews and assesses
Cochrane Database of Systematic Reviews, 07 September 2011 - Publisher: John Wiley & Sons, Ltd
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