BMJ 2011: 342: 115 – 178 (15th January)

Gout and sarcomas.

Gout

A couple of letters added points to the ones covered in the 15th November consultation.  Apparently, guidelines advise 0.5 mg colchicine 2 – 3 times daily for three days.  Thanks – that’s helpful.  Prednisolone, if it’s given (it’s a third-line treatment after colchicine and NSAIDs), should be 25 – 35 mg daily for five days, no tapering.  Check for metabolic syndrome, as it’s strongly associated with gout – so, fasting lipids/glucose, U&Es, and a BP.  Review after the acute attack to discuss lifestyle management.  And urate concentrations may actually be normal in the acute attack and go up again afterwards, so, if concentrations are normal, recheck them once the acute attack has settled.

Sarcomas

I need to be on the watch for these.  I usually assume subcutaneous lumps with no skin involvement are lipomas, so this is an alternative possibility it’s important to be aware of.  Danger signs to look for are masses >5 cm (i.e., the size of a golf ball), pain, increase in size, recurrence after previous excision, or a lump deep to the muscle fascia.  If in doubt, get a scan.  2ww referral, if appropriate, should be to a specialist referral centre, though I don’t actually know where that would be locally.

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About Dr Sarah

I'm a GP with a husband and two young children.
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