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CONTINUING PROFESSIONAL DEVELOPMENT
COUNSELLING IN PRACTICE
Counselling on that toe
You advise Robert that the GP has
prescribed colchicine to relieve the pain
of his acute gout attack. You advise
him to take 2 tablets (1 mg) as soon as
possible, then 1 tablet (500 micrograms)
one hour later. You also advise Robert to
not repeat the course within three days.
You advise Robert that some of the more
common side effects of this medicine
are diarrhoea, nausea and abdominal
discomfort. However, as the treatment
course of colchicine is a total of three
tablets, he is unlikely to have any severe
adverse effects with this medicine.
You explain to Robert that gout is
caused by a build up of uric acid in the
body, which can form crystals in and
surrounding his joints leading to the
pain, redness and inflammation that he
is experiencing. You discuss what can
be done to reduce the risk of another
acute attack, such as reduction in purine
containing foods and alcohol. You also
remind Robert that there is an increased
chance of gout in people who have
You provide Robert with a PSA Self Care
Fact Card Gout which explains his newly
diagnosed condition. He can refer to this
card later, and invite him back to your
pharmacy if he has further questions or
Gout is often associated with other
comorbidities such as diabetes.
Symptoms suggesting gout should be
referred to a GP for diagnosis.
NSAIDs are preferred in an acute attack
but corticosteroids can be used if
NSAIDs are contraindicated. Colchicine
is reserved for use when both NSAIDs
and corticosteroids are inappropriate.
Allopurinol is used for long-term
treatment of gout.
Lifestyle changes are equally important to
treat and prevent attacks of gout.
1. Expert Group for Rheumatology. Therapeutic Guidelines:
Rheumatology. Version 2 ed. Melbourne: Therapeutic
Guidelines 2010. At: http://online.tg.org.au
2. NHS. Gout 2014 [cited Mar 2014]. At: www.nhs.uk/
3. Becker MA, Macdonald PA, MP, Hunt BJ, et al. Diabetes and
Gout: efficacy and safety of febuxostat and allopurinol.
Diabetes Obes Metab 2013;15(11):1049–55 .
4. Yoo TW, Sung KC, Shin HS et al. Relationship between serum
uric acid concentration and insulin resistance and metabolic
syndrome. Circ J 2005;69(8):928–33 .
5. Merriman T et al. Gout: an alarm bell for diabetes and
cardiovascular disease. Best Practice Journal 2011;37:41–3 .
6. Rodriguez G, Soriano L, Choi HK. Impact of diabetes
against the future risk of developing gout. Ann Rheum Dis
7. Rossi S, ed. Australian medicines handbook. Adelaide:
Australian Medicines Handbook; 2014.
1. Which ONE of the following is
CORRECT in regards to gout?
a) A high temperature in the joints may
increase the likelihood of a build up of
uric acid crystals.
b) The most common age of onset in
males is 40–60 years.
c) Gout is a type of rheumatoid arthritis.
d) Gout is characterised by pain and
infection which often begins in one
2. Which ONE of the following is
CORRECT in regards to medicines
used in treating gout?
a) Allopurinol should be avoided in
patients with peptic ulcer disease.
b) NSAIDs are often the preferred
treatment in patients with complex
c) Colchicine can be used in treatment
and prevention of gout attacks.
d) NSAIDs are reserved for when colchicine
and corticosteroids are inappropriate or
3. Which ONE of the following is NOT
a recommended lifestyle strategy to
avoid acute attacks of gout?
a) Reducing dietary intake of beef, pork
b) Reducing intake of beer and spirits.
c) Reducing dietary intake of seafood, liver
d) Reducing non-fructose soft drink intake.
4. Gout is three to four times more
likely to occur in men due to:
a) Reduced serum uric acid in women due
b) Reduced uric acid excretion in men due
to a later age onset.
c) Less space in the soft lining in joints of
d) Increased excretion of uric acid via the
kidneys in women due to oestrogen.
5. The inter-critical gout period is:
a) The asymptomatic interval between
recurrent attacks of acute gout.
b) The time at which colchicine therapy
should be started to treat an acute
attack of gout.
c) The time between first onset of
symptoms and symptom abating in
d) The symptomatic interval of an initial
attack of gout.
Table 1. Adverse effects of medicines used in gout
Best avoided in:
Nausea, dyspepsia, GI ulceration
or bleeding, raised liver enzymes,
diarrhoea, headache, dizziness,
sodium and fluid retention,
Dehydration, asthma, coagulation
disorders, bruising, gastrointestinal
disorders, renal impairment, hepatic
impairment, surgery, elderly,
Colchicine Diarrhoea, nausea, abdominal
History of blood dyscrasias, severe
GI disease, corneal wounds or ulcers,
renal and hepatic impairment
Allopurinol Maculopapular or itchy rash
Asian ancestry, renal impairment and
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