Gout is inflammatory arthritis characterized by recurrent attacks of a red, tender, hot, and swollen joints. Pain typically comes on rapidly in less than twelve hours. The joint at the base of the big toe is affected in about half of cases. It may also result in tophi, kidney stones or urate nephropathy.
Medications:
Acute gout
- Tab. Naprosyn 500 (Naproxen 500 mg) 1 tablet twice a day for 4 – 10 days.
- Tab. Pantakind 40 (Pantoprazole 40 mg) 1 tablet a day on empty stomach for 4 – 10 days.
Do not start uricosuric drugs like Allopurinol until acute attack has subsided completely.
Chronic gout or recurrent attacks
- Tab. Zyloric 100 (Allopurinol 100 mg) 1 tablet once a day. Gradually increase till maximum dose of 100 mg thrice a day OR
- Tab. Febustat 40 (Febuxostat 40 mg) 1 tablet daily. If serum uric acid is > 6 mg/dl after 2 – 4 weeks gradually increase dose till 120 mg/day.
- Tab. Cystone (herbal remedy) 2 tablets twice a day with meals.
General advice:
- Advice rest and cold fomentation during acute phase.
- Ensure adequate hydration.
- Foods to prefer – tomato, oranges, pineapples, cucumber, carrots, lemon, low fat milk.
- Foods to eat in moderation – cauliflower, spinach, mushroom, green peas, dal, dried peas, chickpeas, kidney beans, black eye bean, french beans.
- Foods to be taken in small amount – fish, chicken, mutton.
- Foods to avoid – shellfish and similar sea foods, liver, sardines, mackerel, bakery products, sweets, pizza, chikku, custard apple and pickles.
Investigations:
- Plain x ray of the joint – to identify subcortical cysts without erosion.
- Serum uric acid – raised uric acid is one of the criteria for diagnosing gout
- Renal function test – rule out renal failure
- Aspirate from gouty tophi – this will show urate crystals
- Aspirate from joint fluid – will be negative for microbial culture to rule out septic arthritis
Referral:
Consider referring to rheumatologist in resistant joint swelling and functional difficulties.