_Cold (hence more likelihood of the toe being affected)
_Increased uric acid levels
_Reduced articular hydration
_Extracellular matrix proteins e.g. proteoglycans, collagens and chondroitin sulfate
_Aspirin (even low dose)
_Tumour lysis syndrome (following cytotoxic therapy)
_Myeloproliferative /lymphoproliferative disorders
_Excruciating pain of single joints, mainly big toe
_Erythema and warmth over the effected joints
_Tophi (mainly in pinna and areas underlying olecranon bursa)
_Signs of renal disorder may appear
_Uric acid nephrolithiasis
NSAIDS or COX-2;
_Tabs Ibuprofen 400 - 800mg TID
_IM Diclofenac 75mg STAT the PRN
_Tabs Naproxen 250mg BD
_Other NSAIDS or COX-2s
_Tabs Colchicine, initially one mg then 500mcg every two to three hours until the pain is relieved or vomiting or diarrhoea occur or a total dose of 10mg has been administered. The treatment should not be repeated within 3 days. Prevention of attacks during initial treatment with allopurinol or uricosuric drugs: 500mcg BD or TID.
_Colchicine to prevent acute gout flares during initiation of allopurinol therapy:
*Tabs Colchicine 0.5-0.6mg BD for around 2 weeks THEN
Tabs Allopurinol 100mg OD.
Increase by 100mg monthly (to max. of 400mg/day; average 300mg/day) until the plasma level or uric acid is below 0.3 m m/L
upto life long
*Tabs Probenecid 250mg BD
_Increase Vitamin C uptake (Tabs Vitamin C 1500mg daily is useful)
_Tabs Prednisone or Prednisolone 0.5mg /kg/day x 7-10 days.
_Tabs Prednisone or Prednisolone 0.5mg /kg/day x 2-5 days then taper for 7-10 days.
_IM Triamcinolone 60mg STAT the repeat the prednisone or Prednisolone regime with the above options.