Gout
Examination:
Acute arthritis?
- Big toe MTPJ (70% of first presentation)?
- Midfoot (‘bootlace’ area)?
- Ankle?
- Knee?
- Finger?
- Wrist?
- Elbow?
Trophy (firm white translucent nodules)?
Investigations:
Joint aspiration for microscopy and culture if diagnosis in doubt or septic arthritis suspected
Serum urate of > 360 micro mol/L is needed to confirm the diagnosis (if serum urate < 360 repeat > 2 weeks after an acute attack has settled)
Serum uric acid 4-6 weeks after an acute attack
Management:
Advised:
Affected joints should be rested, elevated and cooled (ice packs may help)
NSAID with PPI OR
Colchicine 500 mcg BD-QDS OR
Joint aspiration and injection with steroid as highly effective option and may be the treatment of choice in patients with significant co-morbidity OR
Prednisolone 35 mg daily for 5 days orally or steroid IM injection if NSAID or colchicine not tolerated or contraindicated and intra-articular injection not feasible
(Notes: choice will depend on patient preference, renal function and co-morbidity)
If monotherapy not effective combination treatments can be used, eg NSAID with either intra-articular or oral steroid or colchicine
To read online info ‘What is Gout?’
Healthy, balance diet
Weight reduction if overweight
Alcohol reduction if excessive alcohol intake
Serum uric acid level 4-6 weeks after an acute attack
After that review by GP
Resource(s):
Information for patient/carer(s):