In Australia, gout is one of the most common forms of inflammatory arthritis that affects adults, with self-reported prevalence rates of up to 6.8%. It is a lifelong condition that primarily causes acute monoarthritis. It is associated with an increased risk of joint damage and deformity, kidney and heart disease. Aetiology includes genetic factors, chronic kidney disease and obesity.
Gout Treatment Algorithm: optimise patient care
My Gout Plan: a plan for patients to record medicines, doses and serum urate levels
Gout and Diet: fact sheet about gout and diet for patients
Webinar: case-based insights on gout care. Watch Beyond the Pain: Best Practice Approach to Managing Gout
Differential diagnosis for gout includes septic arthritis and pseudogout. All of these conditions can have a similar clinical presentation.
Joint aspiration: only way to achieve a definitive diagnosis. Request cell count, microbiology (MCS), and crystal analysis.
Dual Energy CT: visualises uric acid and calcium deposits. It is not considered a tool for routine diagnosis, especially in early disease state.
X-Ray: useful to identify joint damage but not monosodium urate crystals.
Serum urate: levels may be falsely low during an acute flare so should not be solely relied on to make a diagnosis of gout.
For detailed guidance, refer to the Gout Treatment Algorithm.
NSAIDs: consider contraindications and precautions - generally preferred in younger patients.
OR
Prednisolone/prednisone: 15-30 mg orally daily for 3-5 days or intra-articular methylprednisolone if ≤2 joints are affected and reduced systemic absorption desired.
Treat-to-target: aim for <0.36 mmol/L for non tophaceous gout, and <0.30 mmol/L if tophi, gouty arthritis or recurrent attacks are present.
Monitor serum urate concentration, renal, and liver function monthly until target levels are reached.
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Main risk factors for gout are genetic predisposition, impaired kidney function and obesity.
Diet and alcohol intake are no longer thought to play as big a role.
Diet: some foods and beverages may trigger flares but are not the cause of gout. Advise patients to reduce consumption rather than eliminate their intake of alcohol, animal based foods high in purine (i.e. shellfish, fish, red meat) and sugary drinks high in fructose.
Eat a balanced diet and maintain adequate hydration.
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