Musculoskeletal

Gouty Arthritis

گاؤٹ / جوڑوں کا درد

Multiple joint pains and inflammation of the small joints of the hands, burning feet sensations, and symptoms worse after taking meat and eggs. Treat the acute attack with NSAIDs, add supplements, then start urate-lowering therapy after 2 weeks.

ICD-10: —
Source: OPD handbook pp.142, 153–154, 156
Status: Draft

Not yet reviewed by a clinician. Check doses and brands against current national guidelines before use.

Symptoms

Multiple joint pains and inflammation of the small joints of the hands
Burning feet sensations
Symptoms worse by taking meat and eggs

Diagnosis

Take vitals of all patients
Tender, inflamed joints (especially of the hands)
Serum uric acid level: males 3.4–7 mg/dL; females 2.4–5.7 mg/dL

Treatment

Step 1 of 4

1. Acute attack: oral NSAIDs (about 2 weeks)

Choose one NSAID; Pytex 20 mg BD is used in the sample

Prescription

Diclofenac sodiumNSAID

DoseBD

Brand Tab Voren 50 mg

Also sold as Voren, Diclo, Dicloran

PiroxicamNSAID

DoseBD (1+1)

Brand Tab Pytex 20 mg 2 weeks

Also sold as Brysk, Pytex, Brexin, Feldene

IbuprofenNSAID

DoseTDS

Brand Tab Brufen 400 mg

Caution: Avoid in dengue (bleeding risk); Avoid in kidney disease, peptic ulcer, late pregnancy; Take with food

NaproxenNSAID

Dose1+1 for 2 weeks (sample of a hypertensive patient with gout)

Brand Tab Neoprox 500 mg

Also sold as Neoprox, Neopron, Flexin, Synflex

Step 2 of 4

2. Add supplements

Prescription

Methylcobalamin (vitamin B12)Nervine tonic / B12

Dose1 at night (1+0)

Brand Cap Mexamin 500 mcg

Also sold as Neuromet, Mexamine, Cobalamin, Mexamin, Methycobal

Calcium supplementSupplement

DoseAs directed

Brand Cac-1000 Plus

Vitamin E (antioxidant)Antioxidant

DoseOD

Brand Cap Evion 600 mg

Step 3 of 4

3. Urate-lowering therapy

Always start after 2 weeks of the acute attack.

Febuxostat (Tab Gouric): 40–120 mg, start with 40 mg OD for 2 weeks
Allopurinol (Tab Zyloric): 100–300 mg, start with 100 mg OD for 2 weeks
Advise serum uric acid after 2 weeks and follow up every 2 weeks until the normal level is achieved and the patient is symptom free

Prescription

FebuxostatXanthine oxidase inhibitor (urate lowering)

Dose40–120 mg; start 40 mg OD

Brand Tab Gouric / Go-Uric 2 weeks, then review

Also sold as Go-Uric, Gouric

AllopurinolXanthine oxidase inhibitor (urate lowering)

Dose100–300 mg; start 100 mg OD

Brand Tab Zyloric 2 weeks, then review

Step 4 of 4

4. Counselling (Urdu notes)

Avoid meat, eggs, rice and pulses (dals)
Drink more water
Increase milk and lassi

Sample prescriptions from the book (patient details removed)

Female, 40 y, pain in multiple joints especially the small joints of the hands with burning feet, after 2 weeks of NSAIDs (piroxicam); no abnormality on examination; RBS 80–110: Tab Gouric 40 mg 1+0 for 15 days; Tab Pytex 20 mg 1+1 for 2 weeks; Cap Mexamin 500 mcg at night; Cap Evion 600 mg daily; avoid meat, rice, eggs and pulses; drink more water and milk; follow up after 15 days; advise serum uric acid.
Male, 60 y, known hypertensive, pain in wrist joints and burning feet, inflamed joints; BP 160/100: Tab Zodip 5 mg (amlodipine) continue; Tab Zaqnol 50 mg (atenolol) continue; Tab Neoprox 500 mg 1+1 for 2 weeks; Tab Cobalamin 500 mcg daily for 2 weeks; after 2 weeks, Tab Go-Uric 40 mg 1+0 for 2 weeks and continue; avoid salt, spicy foods, meat and eggs.