Gout is a form of microcrystal synovitis caused by the deposition of monosodium urate monohydrate in the synovium. It is caused by chronic hyperuricaemia (uric acid > 450 ┬Ámol/l)


Acute management

intra-articular steroid injection
colchicine* has a slower onset of action. The main side-effect is diarrhoea
oral steroids may be considered if NSAIDs and colchicine are contraindicated. A dose of prednisolone 15mg/day is usually used
if the patient is already taking allopurinol it should be continued

Prevention of recurrence

Indications for allopurinol
recurrent attacks - the British Society for Rheumatology recommend 'In uncomplicated gout uric acid lowering drug therapy should be started if a second attack, or further attacks occur within 1 year'
renal disease
uric acid renal stones
prophylaxis if on cytotoxics or diuretics

allopurinol should not be started until 2 weeks after an acute attack has settled as it may precipitate a further attack if started too early
initial dose of 100 mg od, with the dose titrated every few weeks to aim for a serum uric acid of < 300 ┬Ámol/l
NSAID or colchicine cover should be used when starting allopurinol

Lifestyle modifications

reduce alcohol intake and avoid during an acute attack
lose weight if obese
avoid food high in purines e.g. Liver, kidneys, seafood, oily fish (mackerel, sardines) and yeast products

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