gout

Question 1

gout - complications (3)

Answer 1

chronic kidney disease
tophaceous gout
chronic destructive arthritis

Question 2

gout - nonmedication management (4)

Answer 2

• maintain healthy weight
• reduce ETOH consumption to guideline levels
• avoid high fructose drinks in diet
• avoid purine-rich foods in diet

Question 3

gout - medication for acute flare-up (4 options)

Answer 3

• local injection of corticosteroid to affected joint
• NSAID (naproxen 500mg PO BD for 3-5 days)
• prednisolone 15-30mg PO mane for 3-5 days
• colchicine 1mg PO stat, followed by 0.5microgram dose in 1/24, then stop

Question 4

gout - medication for long term prophylaxis - first line

• initial dosage
• titration schedule
• max dose
• treatment target

Answer 4

allopurinol 100mg PO daily
increase by 50-100mg every 2-4 weeks
max 900mg
until target uric acid concentration reached (0.36 if no tophi, 0.30 if tophi)

Question 5

gout - medication for long term prophylaxis

- add-on to first line if treatment target not achieve

Answer 5

probenecid 250mg PO BD

Question 6

gout management

• common complication of starting or titrating long-term urate therapy
• how to manage this

Answer 6

can cause acute flare-up of gout

colchicine 500microg OD-BD, for up to 6 months