Gout, chronic

M10.00-09/M10.90-99

DESCRIPTION

Gout with one or more of the following:

  • uric acid deposits in and around the joints and cartilages of the extremities (tophi)
  • tophi are most commonly found as hard nodules around the fingers and toes, at the tips of the elbows (olecranon bursae) or at the pinnae of the ears
  • serum uric acid > 0.5 mmol/L
  • bone and cartilage destruction of the fingers and toes with joint swelling and deformity
  • prolongation of attacks, often with reduction in pain severity
  • incomplete resolution between attacks

GENERAL MEASURES

  • If possible, avoid known precipitants and medicines that may increase uric acid, e.g. low dose aspirin, ethambutol, pyrazinamide and diuretics, especially hydrochlorothiazide.

LoEIII

  • Encourage weight loss, if overweight.
  • Avoid alcohol.

MEDICINE TREATMENT

Uric acid lowering therapy is required in all of the following:

  • ≥ 2 acute attacks per year
  • urate renal stones
  • chronic tophaceous gout
  • urate nephropathy

When the acute attack has settled completely, i.e. usually after 3 weeks:

  • Allopurinol, oral, 100 mg daily (Doctor initiated).
    • Increase monthly by 100 mg according to serum urate levels.
    • Titrate dose to reduce serum urate to < 0.35 mmol/L.
    • Allopurinol dosage is dependent on severity of disease and serum urate concentration. Doses in excess of 300 mg should be administered in divided doses.
    • Average dose: 300 mg per day.
    • The elderly and patients with renal impairment require lower doses, start with 50 mg daily, or refer.

LoEIII [9]

REFERRAL

  • Suspected secondary gout.
  • No response to treatment.
  • Non-resolving tophaceous gout.