Each week we will aim to bring out a concise email that provides 4-5 key pieces of information addressing a specific issue in clinical therapeutics. This week:
Acute gout can be very painful and may affect mobility. Although the great toe is commonly affected, other joints may be involved. Men are affected more commonly than women, the onset of symptoms is usually rapid, manifesting over a period of less than 24 hours.
- NSAIDs are usually effective in reducing pain and swelling, but particularly for older people can cause serious adverse effects such as fluid retention and oedema, GI distress, peptic ulceration or gastric bleeding, or acute renal impairment (especially for those also treated with ACE inhibitors).
- An effective alternative for some people is the use of brief course of oral corticosteroid. One approach that has been suggested is based on the administration of prednisolone 10 mg twice daily for three to five days (depending on the speed of resolution of the attack), followed by a stepwise reduction of 10-14 days. Blood glucose concentrations should be monitored for those with diabetes or known impairment of glucose tolerance.
- Allopurinol is used to decrease hyperuricemia and can lessen the likelihood of recurrence – however it is generally not recommended to commence allopurinol during an acute attack of gout.
- Previously used quite extensively, colchicine is now reserved for cases where NSAIDs and corticosteroids are not appropriate. For those with an estimated GFR > 80 ml/min, use 1 mg stat and then a further 0.5 mg an hour later. Do not use if colchicine is already in use for prophylaxis. Avoid in cases where a CYP3A4 inhibitor (e.g. fluvoxamine, erythromycin, itraconazole) is also prescribed.
- Drugs that have been implicated as causes of hyperuricaemia, thereby elevating the risk of acute gout, include frusemide, thiazide diuretics and cyclosporin
Please consider these issues when preparing RMMR reports or education sessions. Contributions of content or suggested topics are welcome and should be sent directly to firstname.lastname@example.org