Gout - all you need for primary care

Dr. Ronan Kavanagh Consultant Rheumatologist Galway Clinic

[object Object],[object Object],[object Object],[object Object],A Medical Colleague in his 50’s

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Uric acid levels normal in 30-50% acute attacks ,[object Object]

Treatment of Acute Gout ,[object Object],[object Object],[object Object],[object Object],[object Object]

Joint aspiration and injection It is possible to find crystals in asymptomatic joints between attacks

Diagnosis ,[object Object],[object Object],[object Object],[object Object]

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6 weeks later ,[object Object],[object Object],[object Object],[object Object]

COMMON REASONS FOR LACK RESPONSE ,[object Object],[object Object],[object Object],[object Object]

TARGET URIC ACID ,[object Object],[object Object],[object Object]

MEDICAL MANAGEMENT OF CHRONIC GOUT Start allopurinol gently (ideally not during acute attack) 100mg od after a week to 300mg od Co-prescribe prophylaxis for 1 st 6 weeks Colchicine 500mcg od Low dose NSAID (avoid in this patient) Low dose steroids (Pred 5-7.5mg daily) Check Urate after a month

[object Object],[object Object],[object Object],[object Object],[object Object],ALLOPURINOL

Allopurinol sensitivity ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],*Arthritis Rheumatism 2009, S60; 761

Treatment adherence rates after 1 year Pharmacotherapy. 2008;28(4):437-443

What about alcohol? ,[object Object],[object Object],[object Object],[object Object],[object Object]

I suppose I’ll have to give up the drink then? O.R. = 2.5 O.R. = 1 O.R. = 1.6 Choi HK et al. Lancet 2004; 363: 1277–81 x2 x2 x2

I might as well drink wine....... O.R. = 2.5 O.R. = 1 O.R. = 1.85 X2 X2 X2

Advise to drinkers ,[object Object],[object Object],[object Object],[object Object]

What about diet? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Diet continued ,[object Object],[object Object],[object Object]

Gout and renal impairment ,[object Object],[object Object],[object Object],[object Object]

Gout in renal failure ,[object Object],[object Object],[object Object]

Do we need to treat hyperuricaemia? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

“ Evidence does not yet support the general treatment of asymptomatic hyperuricaemia to reduce cardiovascular risk” NEJM 2008;359:11811-21

Alternatives to allopurinol ,[object Object],[object Object],[object Object],[object Object],[object Object]

Take home points ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Take home points ,[object Object],[object Object],[object Object]

‘ Keeping the show on the road’ Musicians Health Conference 2012

Saturday October 13th 2012 Radisson Hotel Galway

Gout - all you need for primary care

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