All about gout

Gout - crystalline arthropathy. 
2 main types to know about:
1. Uric acid gout - looks like needles on micro, negatively birefringent crystals
2. CPPD - rhomboid crystals, positively birefringent

Risk Factors:

• High purine diet (e.g. red meats)
• Alcohol
• Dehydration
• Diuretics
• Male sex
• Age
• Post-menopause (pre-menopausal gout is rare - estrogen is protective)

Acute Tx:

• NSAIDs: 50 mg indomethacin bid OR Naproxen 500 mg bid
• Colchicine: Interesting drug, inhibits microtubules? no role for it in non-acute gout, also used in pericarditis. Tx for gout is 0.6 mg po bid
• Prednisone 15-20 mg po daily

The above is for 5 days to 2 weeks
Good to know: Renal dosing of acute gout meds is tough. Prednisone is ok to give in renal impairment.

Chronic Tx: Aim is to reduce uric acid level

• Allopurinol: Xa oxidase inhibitor. Don't start until flare is settled. If person has non-gout symptoms related to high uric acid, like kidney stones or uric acid deposits (tophi), there is a role for allopurinol 
• Good to know: high incidence of hypersensitivity reactions to allopurinol. If this fails, try febuxistat (but not covered by ODB)