Overview:

● Gout is an acute sudden inflammatory disease of the joint caused by high concentrations
of uric acid in the joints and bones.
● There are three stages of gout:
● First, acute gouty arthritis is an attack exhibiting severe pain, redness, and swelling of a
joint, which may last from days to weeks.
● Second, intercritical gout, a period without flares.
● Third, chronic/tophaceous gout, a gout that has been inadequately treated.
● Gout is also one of the most common causes of chronic inflammatory arthritis in the
United States, characterized by monosodium urate (MSU) monohydrate crystals
deposition in the tissues. Gout was first recognized even before the common era.
● Hence it is arguably the most understood and manageable disease among other
rheumatic diseases per the National Library of Medicine.

Common complaints:

● Redness, swelling, warmth, and/or pain in the joint (usually one joint), podagra (big toe).
● The pain is likely to be the most severe in the first 12 to 24 hours.

● History of having severe joints with inflammation in other joints, followed by pain free
episodes.

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Treatments
● NSAIDs if not contraindicated
● Colchicine
● Corticosteroids

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MORE INFORMATION ABOUT TREATMENTS:
● Colchicine is comparably effective to other agents if taken within 24 hours of gout flare
onset. Colchicine has been shown to reduce pain by over 50% in a randomized control
trial at 24 hours compared to a placebo.
● EULAR consensus guidelines for treating acute gout with colchicine advise a maximum
of 3 doses of 0.5mg per day. The total dose of colchicine should not exceed 1.8 mg on
day 1 (either 1.2 mg for the first dose followed by 0.6 mg an hour later [US Food and
Drug Administration (FDA) approved dose] or 0.6 mg three times on the first day.] On
subsequent days, colchicine should be taken once or twice daily until the resolution of a
gout flare.
● A reduced dose of colchicine may be required for patients with diminished hepatic or
renal function or potential drug interactions. ABCB1 inhibitors like cyclosporine and
clarithromycin may cause colchicine toxicity. Colchicine neuromyopathy may develop
weeks after initiation of cyclosporin.
● High-dose colchicine regimens should not be encouraged due to unacceptably high
toxicity. The adverse effects of colchicine comprise gastrointestinal symptoms (nausea
and diarrhea), myotoxicity, and myelosuppression (leukopenia, thrombocytopenia, and
aplastic anemia). The frequent adverse effects of colchicine are abdominal cramping and
diarrhea. Intravenous colchicine is strongly advised against due to serious adverse
effects, including death.
● Colchicine dosing adjustments for certain high-risk groups of patients should follow the
guidelines provided in the manufacturer's FDA-approved information. Usually, no more
than 0.3 mg dose is administered on the day of a gout flare, and the dose is not
repeated for at least three to seven days or more in such patients. Following are the
high-risk groups:
● Patients taking colchicine prophylaxis within the past 14 days, with normal hepatic and
renal function, who have taken a medication that inhibits P-gp and a potent CYP3A4
inhibitor within the last 14 days

● Patients taking colchicine prophylaxis within the past 14 days, with any hepatic and renal
impairment, who have taken a medication that is a moderate CYP3A4 inhibitor within the
last 14 days
● Patients with advanced hepatic or renal impairment (Child-Pugh C cirrhosis or equivalent
CrCl of <30 mL/minute) regardless of recent colchicine use.

Risk factors
● High levels of uric acid in your body. Factors that increase the uric acid level in your body
include:
● Diet. Eating a diet rich in red meat and shellfish and drinking beverages sweetened with
fruit sugar (fructose) increase levels of uric acid, which increase your risk of gout.
Alcohol consumption, especially of beer, also increases the risk of gout.
● Weight. If you're overweight, your body produces more uric acid and your kidneys have
a more difficult time eliminating uric acid.
● Medical conditions. Certain diseases and conditions increase your risk of gout. These
include untreated high blood pressure and chronic conditions such as diabetes, obesity,
metabolic syndrome, and heart and kidney diseases.
● Certain medications. Low-dose aspirin and some medications used to control
hypertension — including thiazide diuretics, angiotensin-converting enzyme (ACE)
inhibitors and beta blockers — also can increase uric acid levels. So can the use of
anti-rejection drugs prescribed for people who have undergone an organ transplant.
● Family history of gout. If other members of your family have had gout, you're more likely
to develop the disease.
● Age and sex. Gout occurs more often in men, primarily because women tend to have
lower uric acid levels. After menopause, however, women's uric acid levels approach
those of men. Men are also more likely to develop gout earlier — usually between the
ages of 30 and 50 — whereas women generally develop signs and symptoms after
menopause.
● Recent surgery or trauma. Experiencing recent surgery or trauma can sometimes trigger
a gout attack. In some people, receiving a vaccination can trigger a gout flare per the
Mayo clinic.

 

Retrieved from:
https://www.ncbi.nlm.nih.gov/books/NBK546606/
https://www.mayoclinic.org/diseases-conditions/gout/symptoms-causes/syc-20372897