Gout: Cause, Diagnosis and Treatment(cont'd...)
Diagnosis of Gout
A painful red hot swollen joint develops over 2-3 hours and resolves within 2 weeks.
90% of first gout attacks are monoarticular and at first, most often affecting the first metatarsophalangeal joint, and then, in order of frequency, the insteps, ankles, heels, knees, wrists, fingers, and elbows.
Tophi (urate deposits) are uncommon in gouty subjects and are a late complication of hyperuricemia.
The most common sites of tophaceous deposits in patients with recurrent acute gouty arthritis are the base of the great toe, helix of the ear, olecranon bursae, achilles tendon, knees, wrists, and hands.
Increased uric acid level in plasma.
Increased C reactive protein in plasma.
Increased ESR (in chronic condition).
Treatment options of acute Gout
First line treatment: NSAID +/- PPI (proton pump inhibitor).
Alternative or additional treatments: Etoricoxib +/- PPI, Colchicine, Prednisolone.
Reduce or discontinue thiazide diuretics if possible.
Treatment options of chronic Gout
First line treatment: Allopurinol (steroidal), Febuxostat (non steroidal).
Second line treatment: Sulphinpyrazone, Probenecid.
Colchicine 0.5 mg twice daily is used for the first 6-12 months after initiating urate lowering therapy.
Mechanism of actions of chronic anti-Gout agents
NSAIDs: Relief from the signs and symptoms of gouty arthritis (inflammatory responses like pain, swelling and redness), by interrupting the progression of inflammation.
Colchicine: It is an anti-mitotic drug that is highly effective in relieving acute gout attacks but has a low benefit-toxicity ratio. It acts by inhibiting the migration of leukocyte in the affected joints.
Corticosteroids: Used to treat acute attacks of gouty arthritis to the patients with a contraindication or who are unresponsive to NSAID or colchicine therapy. Patients with multiple-joint involvement may also benefit. They act by inhibiting the anti inflammatory responses due to gout as well as by inhibiting the macrophages.
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