Gout (Monosodium Urate Crystal Disease)

Management of acute attack

• Bed rest

• Keep weight of the bedclothes off the foot with a bed cradle or pillow under bedclothes

• NSAIDs (except aspirin): all equally effective and first line; give orally until symptoms abate (up to 4–5 d), then continue for one week or

• Colchicine 1 mg (o) statim, then 500 mg 1 hr later; can be used with other agents or

• Corticosteroids: oral, IM, IV or intra-articular (exclude sepsis), esp. if above inappropriate, e.g. prednisolone 15–30 mg (o) daily until symptoms abate

Note:

• Avoid aspirin and urate pool lowering drugs (probenecid, allopurinol, sulfinpyrazone).

• Monitor kidney function and electrolytes.

Long-term therapy When acute attack subsides preventive measures include:

• weight reduction

• a normal, well-balanced diet

• avoidance of purine-rich food, e.g. organ meats (liver, brain, kidneys, sweetbread), tinned fish (sardines, anchovies, herrings), shellfish and game

• nil or reduced intake of alcohol and sugary drinks, including fruit juices (fructose)

• good fluid intake (e.g. water 2 litres/day)

• avoidance of drugs such as diuretics (thiazide, frusemide) and salicylates

• wearing comfortable shoes

Drug prophylaxis Allopurinol (a xanthine oxidase inhibitor) is the drug of choice.

Dose: 100–300 mg daily

Indications:

• hyperuricaemia (only if patient symptomless)

• frequent acute attacks

• tophi or chronic gouty arthritis

• renal stones or uric acid nephropathy

Method

• Start 6–8 wks after last acute attack

• Start with 50 mg/d for 1st wk → up to 50 mg/wk to 300 mg

• Cover with prednisolone 5 mg/d, colchicine 0.5 mg tds or indomethacin 25 mg bd for 6 mths (to avoid precipitation of gout)