Tasty Morsels of EM 049 – Gout

7 May

As always, this is from the ever expanding google doc on bits and bobs I read and learn from and transfer here for all our learning pleasure. This one from a recent training day with a rheumatologist. Some is literature based some his good old fashioned doctoring and experience.

  • 10-40% have a normal urate during flares
  • the red hot shiny joint is rarely rheumatoid, much more suggestive of gout
  • 95% of nodules are gout or rheumatoid. If you want a really easy diagnosis then crystals of gout are present in huge numbers in a gouty tophus and if you can read or find someone to read a microscope then it might get you out of needling a joint
  • wine less gout forming than beer or spirit
  • coffee protective against gout
  • intense exercise and micro trauma at 1st MTP can precipitate gout
  • podagra was the old school term for classic 1st MTP disease. Knee disease rejoices in the term gonagra

Acute treatment pearls:

  • NSAIDs, if contraindications then topical still great for single joint
  • Colchicine (1.8mg a day) at a low dose, can be used chronically. Remember SEs (sepsis, home marrow suppression. Mostly D&V)
  • Steroids (personally i use steroids a lot for gout in the older folk with comorbidities and a few joints involved)

Chronic treatment pearls:

  • Colchincine can be used
  • Allopurinol: usually wait 6 weeks but can start immediately as long as they get some steroid cover which was news to me

References:

  • Excellent rheumatology lecture somewhere in the midlands of Ireland Spring 2015
  • Featured Image: Nick Gorton, CC License, Wikipedia

Other FOAMed sources

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