Gout
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| Gout | heterogeneous disorder, deposition of uric acid salt or crystal in or ard joints and soft tissue, or crystallization of uric acid in the urinary tract
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| stages of gout | 1. Asymptomatic hyperuricaemia.
2. Acute gouty arthritis.
3. Intercritical gout.
4. Chronic tophaceous gout.
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| First line treatment- acute gout attack NSAIDs 1. diclofenac | 100mg start then 50mg tds for 2 days, then 50mg bds for 8 days.
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| 2. Naproxen | 750mg starts then 250mg tds.
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| 3. Indometacin | 75-100mg bds daily then reduce dose after 5 days.
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| 4. Piroxicam | 40mg/day start dose then reduce to 10-20mg/day
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| 5. Etoricoxib | - only COX2 inhibitor that licensed for gout.
- 120mg OD
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| Colchicine- 2nd line treatment | - given asap as the onset of symptom.
- starting dose at 1mg then give 0.5mg every 2-3 hrs until pain relief.
-s/e: nausea/ vomiting/ diarrhea/ abdominal pain.
-max 6mg
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| corticosteroid | IA injection- unlicensed
prednisolone- 30mg/day for 7 days.
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| Probenecid | - chronic treatment- prophylaxis
- 500mg-1g BD
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| Sulphinpyrazone | - chronic treatment
- 100mg tds/qds
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| Xanthine oxidase inhibitors- allopurinol | - 100mg initial dose and increased every 3-4 weeks as necessary.
- 100-600mg.
- 300mg daily reduce serum urate to normal.
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| Febuxostat | - 40-80mg daily.
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