DR Medhat MRCP

أهم مافي الموضوع في االمتحان • Management of gout
A. Acute management:
NSAIDs (for 2 weeks)
Intra-articular steroid injection. (repeat aspiration & inject depomedrole if the
pain fails tosettle with NSAIDs)
Colchicine*
- Has a slower onset of action.
- The main side-effect is diarrhoea.
سؤال - If the patient is already taking allopurinol it should be continued
- Mechanism of action : Anti-inflammatory effect by:
o Inhibits microtubule polymerization by binding to tubulin, interfering
with mitosis inhibition of mitosis.
o Also inhibits neutrophil motility and activity.
هام جدا وناس كثير مش عارفة هذه المعلومة : impairment Colchicine in renal
- Colchicine is useful in patients with renal impairment who develop acute gout
as NSAIDs are relatively contraindicated.
- The BNF advises to reduce the dose by up to 50% if creatinine clearance is less
than 50 ml/min and to avoid if creatinine clearance is less than 10 ml/min.
B. Allopurinol(zyloric®) prophylaxis :
- If a patient is already on allopurinol prophylaxis & he developed acute gouty
arthritis while he is already on allopurinol , he should start acute ttt with
هام جدا – . allopurinol continuation of same dose of
- Allopurinol should not be started until 2 weeks after an acute attack has
هام جدا early. settled as it may precipitate a further attack if started too
- Initial dose of 100 mg od, with the dose titrated every few weeks to aim for
a serum uric acid of < 300 µmol/l.
- NSAID or colchicine cover should be used when starting allopurinol.
- Indications for allopurinol**
1. 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'.
2. Tophi.
3. Renal disease.
4. Uric acid renal stones.
5. Prophylaxis if on cytotoxics or diuretics
خد بالك
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