Gout : Mnemonics

Urate Lowering Therapy (ULT)

Mnemonic: 1, 2, 3, 4, 5, 6

Start Urate Lowering Therapy if:

1. ≥1 subcutaneous tophi
2. ≥2 flares per year
3. ≥3 stage CKD with Serum uric acid (SUA) ≥ 9 mg/dl

Other indications: Urate renal stone, Evidence of joint destruction in X-ray

4. ≥4 weeks to be waited after last flare to start ULT

5. 5 days to start and taper anti-inflammatory for acute flare

6. <6 mg/dl is the target SUA

Hyperuricemia is defined as serum uric acid (SUA) level >7 mg/dl in men and >6 mg/dl in women.

Causes of Gout

Mnemonic: DRINK NO ALCOHOL

1. Dehydration, Diuretics (Furosemide, Thiazides)
2. Rash (Psoriasis)
3. Idiopathic
4. Nicotinic acid
5. Killing cells (Cytolytic therapties)
6. Nephron failure (renal failure)
7. Obesity (risk factor for primary gout)
8. Acidosis (DKA, lactic acidosis, starvation), Alcohol, Aspirin (low-dose)
9. Lead poisoning, Lesch-Nyhan syndrome
10. Cyclosporine
11. Over-exercising (Extreme exercise)
12. High purine diet
13. Other drugs (ethambutol, pyrazinamide)
14. Lymphoproliferative or myeloproliferative disorders

Mnemonic for crystals in gout and pseudogout

References:

1. FitzGerald JD, Dalbeth N, Mikuls T, Brignardello-Petersen R, Guyatt G, Abeles AM, Gelber AC, Harrold LR, Khanna D, King C, Levy G, Libbey C, Mount D, Pillinger MH, Rosenthal A, Singh JA, Sims JE, Smith BJ, Wenger NS, Bae SS, Danve A, Khanna PP, Kim SC, Lenert A, Poon S, Qasim A, Sehra ST, Sharma TSK, Toprover M, Turgunbaev M, Zeng L, Zhang MA, Turner AS, Neogi T. 2020 American College of Rheumatology Guideline for the Management of Gout. Arthritis Care Res (Hoboken). 2020 Jun;72(6):744-760. doi: 10.1002/acr.24180. Epub 2020 May 11. Erratum in: Arthritis Care Res (Hoboken). 2020 Aug;72(8):1187. Erratum in: Arthritis Care Res (Hoboken). 2021 Mar;73(3):458. PMID: 32391934.
2. Apley and Solomon’s System of Orthopaedics and Trauma – 13th Edition

Dr. Sulabh Kumar Shrestha, MS Orthopedics

He is the section editor of Orthopedics in Epomedicine. He searches for and share simpler ways to make complicated medical topics simple. He also loves writing poetry, listening and playing music.