Gout

Dr Swapnil Pawar November 8, 2021 58

Gout
Dr Swapnil Pawar

Written by – Dr Andrew Lam

Gout vs. Pseudogout

	Gout	Pseudogout
Predominant Sites Affected	Small Joints (i.e. 1st MTP)	Large Joints (i.e. knee)
Clinical Findings	Marked swelling, erythema and tenderness +/- tophi	Swelling and tenderness often less marked than in gout
Pathophysiology	Uric acid crystal deposition	Calcium pyrophosphate crystal deposition
Microscopy Findings	Negatively birefringent, needle-like crystals	Positively birefringent, rhomboid crystals
Radiological Findings	Lytic bony erosions with overhanging sclerotic margins Tophi	Chondrocalcinosis Subchondral cysts

Risk Factors for Gout

Non-Modifiable

Older age
Male

Modifiable

High purine diet
Alcohol
Obesity
Hypertension
Diabetes Mellitus
Hypercholesterolaemia
Chronic Kidney Disease

Management of Gout

Acute Flare

Management of an acute gout flare is based on patient comorbidities and contraindications to potential therapy. Options can include:

NSAID’s (i.e. indomethacin)
Oral steroids (i.e. prednisone)
Colchicine
Intra-articular steroid injections

Urate Lowering Therapy

Urate lowering therapy can be used to prevent further gout glares. The initiation of urate-lowering therapy should be done after acute flares have resolved, as the therapy itself can precipitate an acute gout flare. Options to lower uric acid levels include:

Non-Pharmacological:

Weight loss
Decrease alcohol intake
Decrease purine intake
Management of other risk factors (i.e. hypertension, hypercholesterolaemia, kidney failure)

Pharmacological:

Allopurinol (First line)
Probenecid
Febuxostat

N.B. Low dose colchicine can be given prophylactically to prevent a flare when commencing urate-lowering therapy.

References:

eTG Complete (2021). Gout. Therapeutic Guidelines. Retrieved 30th September 2021 from https://tgldcdp.tg.org.au.acs.hcn.com.au/viewTopic topicfile=gout&guidelineName=Rheumatology&topicNavigation=navigateTopic#toc_d1e232

Gaffo, A.L. (2021) Clinical manifestations and diagnosis of gout. UpToDate. Retrieved 30th September 2021 from https://www.uptodate.com.acs.hcn.com.au/contents/clinical-manifestations-and-diagnosis-of-gout

Rosenthal, A.K. (2021) Clinical manifestations and diagnosis of calcium pyrophosphate crystal deposition (CPPD) disease. UpToDate. Retrieved 30th September 2021 from https://www.uptodate.com.acs.hcn.com.au/contents/clinical-manifestations-and-diagnosis-of-calcium-pyrophosphate-crystal-deposition-cppd-disease

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