Gout and pseudogout - Revision history

Danbot: Add MedicationDose entries (indomethacin, naproxen, ibuprofen, colchicine, prednisone) with SMW annotations

2026-03-20T18:24:48Z

Add MedicationDose entries (indomethacin, naproxen, ibuprofen, colchicine, prednisone) with SMW annotations

@@ Line 79: / Line 79: @@
 **100 mg subq once daily until symptom improvement; usual duration: 3 to 5 days
 **NOT routinely used in the ED.
 ==Disposition==

2022-04-30T15:29:40Z

Evaluation

← Older revision		Revision as of 15:29, 30 April 2022
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	**High uric acid is >6.8		**High uric acid is >6.8
	*ESR may be elevated		*ESR may be elevated
	*'''no bacteria on [[Gram Stain]]'''		*'''No bacteria on [[Gram Stain]]'''
	*Pseudogout: X-ray of joint space may ~~have~~ radiolucent calcium pyrophosphate ~~formation~~		*Pseudogout: X-ray of joint space may show radiolucent calcium pyrophosphate crystals
	{{Arthrocentesis diagnostic chart}}		{{Arthrocentesis diagnostic chart}}

2022-04-30T15:25:22Z

Evaluation

← Older revision		Revision as of 15:25, 30 April 2022
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	==Evaluation==		==Evaluation==
	*Synovial fluid aspiration		*Synovial fluid aspiration
	**Gout~~: yellow monosodium urate; negatively~~ birefringent; needle-shaped		**Gout = Negatively birefringent, needle-shaped monosodium urate crystals
	**Pseudogout~~: calcium pyrophosphate; positively~~ birefringent; rhomboid-shaped		**Pseudogout = Positively birefringent, rhomboid-shaped, calcium pyrophosphate crystals
	*Serum uric acid levels are not helpful (30% of patients with gout attack have normal levels)		*Serum uric acid levels are not helpful (30% of patients with gout attack have normal levels)
	**Uric acid during attacks can be low due to the precipitation of gout crystals		**Uric acid during attacks can be low due to the precipitation of gout crystals
Line 33:		Line 33:
	*ESR may be elevated		*ESR may be elevated
	*'''no bacteria on [[Gram Stain]]'''		*'''no bacteria on [[Gram Stain]]'''
	*Pseudogout: XR of joint space may have radiolucent calcium pyrophosphate formation		*Pseudogout: X-ray of joint space may have radiolucent calcium pyrophosphate formation
	{{Arthrocentesis diagnostic chart}}		{{Arthrocentesis diagnostic chart}}

2022-01-21T03:05:48Z

Management

← Older revision		Revision as of 03:05, 21 January 2022
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	====Glucocorticoid injection====		====Glucocorticoid injection====
	*Even if gout has been diagnosed in the past, be cautious with glucocorticoid joint injection if the current clinical picture is uncertain since a [[Septic Arthritis\|septic joint]] can coexist with gout and a steroid injection would then worsen the patient's clinical status.		*Even if gout has been diagnosed in the past, be cautious with glucocorticoid joint injection if the current clinical picture is uncertain since a [[Septic Arthritis\|septic joint]] can coexist with gout and a steroid injection would then worsen the patient's clinical status.


			====Other Therapies====
			*[[Anakinra]]
			**Disease-modifying agent; Interleukin-1 Receptor Antagonist
			**Reserve use for patients who have frequent flares and in whom first-line therapies are ineffective, contraindicated, or not tolerated
			**100 mg subq once daily until symptom improvement; usual duration: 3 to 5 days
			**NOT routinely used in the ED.

	==Disposition==		==Disposition==

2020-03-10T23:21:56Z

Management

@@ Line 38: / Line 38: @@
 ==Management==
 ''Patients usually only require [[opioid]] and [[NSAID]] treatment in the ED with continued [[NSAID]] treatment as an oupatient. However any combination of the following treatments are acceptable<ref>Khanna D. et al. 2012 American College of Rheumatology guidelines for management of gout. Part 2: Therapy and antiinflammatory prophylaxis of acute gouty arthritis. Arthritis Care Res. Oct 2012;64(10):1447-61</ref>''
 ===[[NSAIDs]]===
@@ Line 64: / Line 71: @@
 ====Glucocorticoid injection====
 *Even if gout has been diagnosed in the past, be cautious with glucocorticoid joint injection if the current clinical picture is uncertain since a [[Septic Arthritis|septic joint]] can coexist with gout and a steroid injection would then worsen the patient's clinical status.
 ==Disposition==

2019-10-29T21:03:04Z

Clinical Features

← Older revision		Revision as of 21:03, 29 October 2019
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	[[File:Gout2018.jpg\|thumb\|Acute gout affecting the first MP joint (podagra)]]		[[File:Gout2018.jpg\|thumb\|Acute gout affecting the first MP joint (podagra)]]
	[[File:PMC3117776 1757-1146-4-13-2.png\|thumb\|Tophaceous gout affecting the right great toe and finger interphalangeal joints. Note the asymmetrical swelling and yellow-white discoloration]]		[[File:PMC3117776 1757-1146-4-13-2.png\|thumb\|Tophaceous gout affecting the right great toe and finger interphalangeal joints. Note the asymmetrical swelling and yellow-white discoloration]]
			[[File:PMC3117776 1757-1146-4-13-1.png\|thumb\|Distribution of joints typically affected by gout]]
	*Joint pain may develop over period of hours		*Joint pain may develop over period of hours
	*Primarily involves first MTP, knee, ankle		*Primarily involves first MTP, knee, ankle

2019-10-29T20:55:34Z

Clinical Features

← Older revision		Revision as of 20:55, 29 October 2019
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	==Clinical Features==		==Clinical Features==
	[[File:Gout2018.jpg\|thumb\|~~Gout~~ affecting the first MP joint (podagra)]]		[[File:Gout2018.jpg\|thumb\|Acute gout affecting the first MP joint (podagra)]]
			[[File:PMC3117776 1757-1146-4-13-2.png\|thumb\|Tophaceous gout affecting the right great toe and finger interphalangeal joints. Note the asymmetrical swelling and yellow-white discoloration]]
	*Joint pain may develop over period of hours		*Joint pain may develop over period of hours
	*Primarily involves first MTP, knee, ankle		*Primarily involves first MTP, knee, ankle

2019-05-10T01:29:17Z

← Older revision	Revision as of 01:29, 10 May 2019
(No difference)

2019-03-06T07:33:18Z

Clinical Features

← Older revision		Revision as of 07:33, 6 March 2019
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	==Clinical Features==		==Clinical Features==
	[File:Gout2018.jpg\|thumb\|Gout affecting the first MP joint (podagra)]]		[[File:Gout2018.jpg\|thumb\|Gout affecting the first MP joint (podagra)]]
	*Joint pain may develop over period of hours		*Joint pain may develop over period of hours
	*Primarily involves first MTP, knee, ankle		*Primarily involves first MTP, knee, ankle

2019-03-06T07:33:07Z

Clinical Features

← Older revision		Revision as of 07:33, 6 March 2019
Line 15:		Line 15:

	==Clinical Features==		==Clinical Features==
			[File:Gout2018.jpg\|thumb\|Gout affecting the first MP joint (podagra)]]
	*Joint pain may develop over period of hours		*Joint pain may develop over period of hours
	*Primarily involves first MTP, knee, ankle		*Primarily involves first MTP, knee, ankle