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Risk factors

  • 30% have uric acid > 0.6 mml/l [>=10mg/dl]
  • Age, male, OA, Fhx, diet [red meat, seafoods], alcohol, drug [thiazide], metabolic syndrome, obesity, CKD, HTN, CCF

Investigate

  • Leucoytosis/ESR/CRP. Uric acid in 2 weeks – [uric acid up in lympho/myloproliferative, B12 deficiency, hypothyroidism]
  • CVD risk factor bloods.

Acute attack

  • Indomethacin 50mg TDS or Naproxen 500mg BD
  • Colchicine 500 micrograms – Take one tablet 3 times a day until symptoms resolve. Maximum 12 tablets per course. Course not to be repeated within 3 days. [12 tablets]
  • Prednisolone & paracetamol or NSAID
  • Do not stop allopurinol

Prevention

  • Indication – > 1 attack per year, chronic arthropathy, trophi, renal impairment, joint damage on radiography, need diuretic therapy
  • Colchicine 0.5 micrograms [or NSAID for 6w] – Take one tablet two times a day for 6 months when starting treatment with (Allopurinol)
  • Allopurinol [start 50mg to 100mg – 50mg in severe RF] or febuxostat (intolerant to allopurinol or allopurinol CI) [80mg OD, ^ to 120mg OD after 4w if uric acid > 6g/dl]
  • Start 2w after attack
  • Increase in 50mg to 100mg incriments – Aim dose 300mg OD
  • Uric acid target =< 5mg/dl, 0.3 mm/l, check FBC, U&E, LFT, Uric acid every 4w
  • Have blood check in 4 weeks to monitor, then come for a review with a doctor after 1 week to discuss increasing dosage.

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