Update on the diagnosis and management of gout

Abstract

Gout is a common clinical problem encountered by both general and specialist clinicians. The key principles in gout management include establishing a definitive diagnosis, the swift treatment of acute attacks, and using urate-lowering therapies appropriately to prevent further attacks and joint damage. The gold standard diagnostic tool for gout remains the identification by polarised light microscopy of monosodium urate crystals in synovial fluid or in a tophus. Emerging diagnostic imaging techniques and novel therapies show promise in the diagnosis and treatment of gout. In most cases, using existing therapies judiciously remains the key determinant of success in managing gout.

Is colchicine more effective to prevent periodic fever, aphthous stomatitis, pharyngitis and cervical adenitis episodes in Mediterranean fever gene variants?

“…Microtubules, key components of the cytoskeleton, are involved in various cellular processes including maintenance of cell shape, intracellular trafficking, cytokine and chemokine secretion, cell migration, and regulation of ion channels and cell division. The therapeutic use of colchicine has been well documented in gout, FMF and Behçet disase . The cause remains obscure but overexpression of inflammasome‐related genes and increase in IL‐1β during attacks in PFAPA suggest an autoinflammatory mechanism.…”

“…The therapeutic use of colchicine has been well documented in gout, FMF and Behc ßet disase. 19,26 The cause remains obscure but overexpression of inflammasome-related genes and increase in IL-1b during attacks in PFAPA suggest an autoinflammatory mechanism. Similarly to FMF, T-helper (Th)1 activation is responsive to IL-1 blockade.…”

A survey on the beliefs and knowledge of gout management in new medical graduates ‐ New South Wales, Australia

“…This may be indicative of guidelines having reduced accessibility, new graduates being unaware of published guidelines or gout being seen as a low priority during medical training . At the time of the study, Australian‐specific guidelines were available, thus the latter may be a more plausible theory. A lack of awareness of guidelines has been demonstrated in studies of GPs who often contribute to the teaching of gout management during students’ practical experiences.…”

“…Most (92%) answered that they would wait to initiate ULT after an acute attack. This view likely stems from a previous belief that initiating ULT during an acute attack may prolong or worsen it's severity; therefore ULT should be commenced in the inter‐critical phase. However, two recent trials have not supported this hypothesis when using allopurinol as ULT .…”

Gouty Tophi: Two Case Report

“…Management of gout must include a definitive diagnosis (clinical, and laboratory features, presence of tophi, ultrasound examination, and demonstration of MSU crystals in synovial fluid or in the tophus); a swift treatment of acute attacks, use of urate-lowering therapies for prevention and lifestyle advice (optimizing weight, restriction intake of purinesrich food and limiting alcohol consumption). 5,6 Treatment of acute attacks includes non-steroidal antiinflammatory drugs, low-dose colchicine regimen and oral, intramuscular or intraarticular corticosteroids. Allopurinol is the first-line medication for reducing serum uric acid.…”