Gout, Chronic

Description

General Measures

Medicine Treatment

Referral

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ICD-10 Code: 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

LoE:III

• 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 

LoE:III²⁹⁰

• Average dose: 300 mg per day
• The elderly and patients with renal impairment require lower doses start with 50 mg daily, or refer

REFERRAL

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

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Standard Treatment Guidelines and Essential Medicines List for South Africa, Primary Healthcare Level, 2024 Edition