Gout Management
- Diet (small effect)
- Stop diuretics
- Weight
- Alcohol
Acute attacks
- NSAID
- Colchicine
- Steroid injection (large joints)
Prophyllaxis
Allopurinol if
- Urate >0.7
- Tophaceous gout
- Urate nephropathy
- >2-3 acute attacks
Treatment usually lifelong
Check creatinine: use lower doses of allopurinol if impaired renal function
| Allopurinol regime |
|---|
| Allopurinol 100mg/day for 1 month |
| Check urate |
| Increase dose by 100mg/month until urate normal (to 400mg) |
Urate will drop within a few days of starting allopurinol, but joint crystals take 6 months to dissolve, so can still get acute attacks in this period. Therefore cover with NSAID for 6 months.
Urate levels: Upper limit of normal is 2SD of a normal gaussian distribution, but urate crystallises out in the joints below this level. Thus it is possible to have acute gout with a "normal" urate (usually first attack in men).