Podcast
Questions and Answers
What proportion of individuals with gout have metabolic syndrome?
What proportion of individuals with gout have metabolic syndrome?
Which of the following dietary factors does not increase the risk of gout?
Which of the following dietary factors does not increase the risk of gout?
Which type of diuretics is most commonly associated with secondary gout?
Which type of diuretics is most commonly associated with secondary gout?
Which of the following medications can lead to hyperuricaemia?
Which of the following medications can lead to hyperuricaemia?
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What is the characteristic onset of pain in acute gout attacks?
What is the characteristic onset of pain in acute gout attacks?
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What is the effect of vitamin C on uric acid?
What is the effect of vitamin C on uric acid?
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Which of the following is an independent risk factor for the development of gout?
Which of the following is an independent risk factor for the development of gout?
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What is the effect of coffee consumption on the risk of gout?
What is the effect of coffee consumption on the risk of gout?
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What is the serum uric acid level at which hyperuricemia is defined?
What is the serum uric acid level at which hyperuricemia is defined?
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Which of the following joints is most commonly affected in gout?
Which of the following joints is most commonly affected in gout?
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What is the duration of a typical gout attack?
What is the duration of a typical gout attack?
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What is the term for gout affecting the big toe?
What is the term for gout affecting the big toe?
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What is the underlying cause of chronic hyperuricemia?
What is the underlying cause of chronic hyperuricemia?
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Which of the following is NOT a common site of gouty arthritis?
Which of the following is NOT a common site of gouty arthritis?
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What is the term for the inflammatory condition resulting from uric acid crystal deposition?
What is the term for the inflammatory condition resulting from uric acid crystal deposition?
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What is the age-related characteristic of gout?
What is the age-related characteristic of gout?
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What may be needed when NSAIDs are contraindicated or ineffective in treating gout?
What may be needed when NSAIDs are contraindicated or ineffective in treating gout?
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What should be avoided in diet during an acute gout attack?
What should be avoided in diet during an acute gout attack?
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What may exacerbate gout attacks?
What may exacerbate gout attacks?
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What is the recommended management for chronic or recurrent gout?
What is the recommended management for chronic or recurrent gout?
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What is a lifestyle modification that may help reduce the risk of gout attacks?
What is a lifestyle modification that may help reduce the risk of gout attacks?
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What should be stopped during an acute gout attack?
What should be stopped during an acute gout attack?
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What may be useful in addition to systemic corticosteroids during an acute gout attack?
What may be useful in addition to systemic corticosteroids during an acute gout attack?
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What is a benefit of using losartan as an antihypertensive medication in gout patients?
What is a benefit of using losartan as an antihypertensive medication in gout patients?
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Study Notes
Comorbidities
- Metabolic syndrome is a multiplex risk factor for atherosclerotic cardiovascular disease that consists of dyslipidaemia, raised blood pressure, increased blood glucose, and both prothrombotic and pro-inflammatory states.
- Metabolic syndrome is present in 63% of those with gout compared with 25% of those without gout.
- Obesity, weight gain, and hypertension are independent risk factors for the development of gout.
Diet
- A purine-rich diet increases the risk of gout.
- Consumption of meat increases the incidence of gout.
- A diet high in purine-rich vegetables does not increase the risk of gout.
- The consumption of low-fat dairy products reduces the relative risk of gout.
- Vitamin C (ascorbic acid) has a modest uricosuric effect.
- Coffee consumption may reduce the risk of the development of gout.
Medication
- The use of both loop and thiazide diuretics is the most common risk factor for secondary gout, especially in the elderly.
- Drugs that decrease renal uric acid clearance include:
- Diuretics
- Salicylates (Low Doses)
- Ethanol
- Levodopa
- Pyrazinamide
- Ethambutol
- Cyclosporine
- Cytotoxic drugs
Clinical Presentation
- Acute gout attacks are characterized by rapid onset of pain, swelling, and inflammation.
- Gout is an inflammatory condition of the arthritis-type that results from deposition of uric acid crystals in joint spaces or surrounding tissues.
- It is associated with hyperuricemia, defined as a serum uric acid (SUA) level of 6.8 mg/dL (404 μmol/L) or greater.
Gout
- Gout is the most common inflammatory joint disease in men and is strongly age-related.
- Gout is a type of arthritis caused by uric acid crystal deposition in joints and soft tissues, resulting in intense pain of sudden onset, swelling, and inflammation.
- The base of the big toe is most commonly affected, but it can occur in any joint.
- Attacks typically last 3–10 days and are usually recurrent.
Management
- Allopurinol and uricosurics should not be started during an acute attack.
- Simple analgesics may be used in addition if necessary.
- Diuretics should be stopped if for hypertension.
- Losartan should be considered as an alternative antihypertensive due to its modest uricosuric effects.
- Lifestyle changes include:
- Resting the joint during an acute attack
- Using ice packs and splinting
- Adopting a weight reduction programme if obese
- Avoiding high-protein, low-carbohydrate diets
- Moderating exercise once the acute attack has subsided
- Avoiding foods with a high purine content such as red meat, shellfish, and yeast extracts.
Management of Chronic or Recurrent Gout
- Allopurinol should be started at 50–100mg daily and increased by 100mg every 2–4 weeks until symptom control is achieved.
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Description
Learn about the connection between metabolic syndrome and various comorbidities, including gout, obesity, and hypertension. Understand the risk factors and prevalence of metabolic syndrome.
