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See Latest ArticlesGout
The Clinical Advisor, 09/18/09
Brier M – Disorder with a heterogeneous group of clinical presentations resulting from tissue deposition of monosodium urate crystals.
Testing:
- Synovial fluid analysis/culture needed to exclude septic arthritis if patient is febrile and has leukocytosis
- Serum uric acid ( >6.8 mg/dL [404 micromol/L] is sufficient for crystal precipitation; level often normal during acute attack).
- X–ray may help confirm.
- 24–hour urine uric acid level as adjunctive test for 1) Identifying/excluding overproducers of urate 2) Patients being considered for uricosuric therapy
- Blood culture to rule out infection
- Oral nonsteroidal anti–inflammatory drugs (NSAIDs) at maximum dose for one to two weeks (drugs of choice for symptomatic relief)
- Colchicine effective but slower to work than NSAIDs
- Corticosteroids, especially in patients with contraindications to NSAIDs
- Rest, ice packs, joint elevation ("Bed cage" may keep bedclothes off inflamed joint.)
- Avoid alcohol; ensure adequate fluid intake (>2 L water daily).
- Allopurinol should not be started or discontinued during acute attack (avoid sudden changes in serum urate levels).
- Consider discontinuation of diuretics.
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