Gout

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INTRODUCTION

Gout is caused by high uric acid. The word gout is from guttate that means drops. Uric acid crystalizes and these crystals wreak havoc when deposited in joints, skin, and kidneys.

Epidemiology

Gout affects approximately 5% of US adults and hyperuricemia is present in approximately 20%of US adults.

Clinical picture

TREATMENT

General approaches

Self management

Diet

Avoid high fructose corn syrup
Low salt
Avoid shellfish, turkey, anchovies

What is the risk of a second attack after one gout episode?

Pharmacologic

Acute flare

NSAID

Nonsteroidal anti-inflammatory drugs (NSAIDs) are effective in treating acute flares and are generally well-tolerated. However, they can have adverse effects, including gastrointestinal upset or bleeding, hyperkalemia, increases in creatinine, and fluid retention. Older and dehydrated patients are at particular risk, especially if there is a history of renal disease. Virtually any NSAID used in anti-inflammatory (high) doses is effective and is likely to exert an analgesic effect beginning within a few hours. Treatment should be continued for several days after the pain and signs of inflammation have resolved to prevent relapse. [1]

Celecoxib

200 mg. BID for one week then discontinue. Oral: Initial: 400 mg, followed by 200 mg approximately 12 hours later on day 1, then continue 200 mg twice daily thereafter; maximum daily maintenance dose: 400 mg/day discontinue 2 to 3 days after resolution of clinical signs; usual duration: 5 to 7 days [2]