January 26, 2023

Contributor: Don Stader, MD

This is the emergency medical minute sponsored by health one okay so uh we’re not going to talk about drugs today so that’s a new thing right uh we’re going to talk about our favorite crystalline arthropathy which is gout yay out okay so gout’s caused by your a crystals how many of you’ve had an actual gout attack no none of you okay great i’ve had i think what

It was a mild one and they hurt like hell and you’ll oftentimes see patients come in for gout attacks right so what are the kind of treatments that we use for gout allopurinol is a treatment to actually prevent gap so so actually allopurinol is great to decrease uric acid levels and prevent gout but when people are in an acute flare uh doesn’t really reservoir

Indusin so innocent and nsaids are kind of one of the hallmarks of treatment uh indocent’s one of the stronger nsaids but has a lot more kind of side effects so it’s kind of lost some favor recently to treat gout more commonly is treated now with like naproxen and like even traditional ibuprofen but nsaids are a hallmark of treatment what other medicines do we

Use steroids prednisone is great right so gout remember like what type of pain has got it’s all inflammatory pain so gout is caused by like you know all these crystals in your joint your body gets pissed off that there they send a bunch of neutrophils out so it’s all inflammatory pain so nsaids anti-inflammatories steroids and then there’s one last one that’s

Treated that’s used to treat cat culture scene how many have used colchicine before right so culture scene is kind of the topic of a medical minute then so culture scene is a drug that we don’t use very much and culture scenes a very interesting drug because how it works is it disrupts microtubules right so it prevents kind of your white cells from being able to

Like get into the joint space because it disrupts their motility and uh colchicine uh usually like there’s two ways you give it you can either give like point six like once and like three times a day after the thereafter or you can give this like big ass dose of like 1.2 and then zero point seconds afterwards so one thing that i did not know when i was reading

A recent article about it is colchicine is actually a really nasty drug so when you give a big dose of like 1.2 it’s around 50 plus of your patients get really explosive diarrhea afterwards so it’s like yeah your joint feels better but maybe hey it’s not the greatest thing i put you on right you’re trading one problem for another um the other thing about culture

Scene that’s really interesting is it’s a terrible terrible drug in overdose so culture scenes one that if you put people on culture scene and let’s say they go home and like overdose on it or you they have a prescription and they overdose on it that’s one that there’s absolutely no treatment for and if you get above like a 0.8 uh milligrams per deciliter thing

It’s like universally fatal so you just die uh and it’s like well out of luck you can’t be dialyzed it can’t be you know it’s filtered out in any way so it’s a nasty drug in that respect um and i just had no idea that the kind of other side effects of like diarrhea etc were so common um so hidden on colchicine don’t know if i’ll be using it a lot and then finally

Don’t use opioids on gout it’s just not effective right okay thank you friends hello i’m dr stephen bradley anesthesiologist and u.s naval officer i’m also the host and creator of the black doctors podcast this podcast provides weekly 30-minute episodes that tell the stories of minority healthcare professionals it is my hope that hearing these unique and inspiring

Stories will encourage others to consider pursuing these challenging and rewarding career paths so please join me for the black doctors podcast available on apple podcast spotify and all major streaming platforms

Transcribed from video
Podcast 585:  You Sure You Want Colchicine for Gout? By Emergency Medical Minute