Gout and pseudogout: Difference between revisions
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##Can be used as alternative agent to NSAIDs in pt w/ normal renal/hepatic function | ##Can be used as alternative agent to NSAIDs in pt w/ normal renal/hepatic function | ||
##1.2mg PO (load), followed by 0.6mg/hr PO until efficacy or side effects occur (vomiting/diarrhea) | ##1.2mg PO (load), followed by 0.6mg/hr PO until efficacy or side effects occur (vomiting/diarrhea) | ||
# | #Continue uric acid-lowering agents if already on prophylactic regimen (do not start) | ||
#Hold diuretic, if on | #Hold diuretic, if on | ||
##Start losaran to replace diuretic (has modest uricosuric effect) | ##Start losaran to replace diuretic (has modest uricosuric effect) | ||
Revision as of 05:01, 8 August 2012
Pathophysiology
- Primarily an illness of middle-aged and elderly adults
- Gout is most common form of inflammatory joint disease in men >40yr
- Presence of crystals does not exclude septic arthritis
- Precipitants
- Trauma
- Surgery
- Significant illness
- Change in medication
Clinical Features
- Joint pain may develop over period of hours
- Primarily involves first MTP, knee, ankle
Diagnosis
- Synovial fluid aspiration
- +crystals, no bacteria on Gram stain
- Serum uric acid levels are not helpful (30% of pts w/ gout attack have normal levels)
- ESR may be elevated
Treatment
- NSAIDs
- Do not give to pts w/ renal insufficiency (use opioids instead)
- Substantial pain relief should occur within 2hr
- Indomethacin 50mg po TID x3-5d
- Colchicine
- Can be used as alternative agent to NSAIDs in pt w/ normal renal/hepatic function
- 1.2mg PO (load), followed by 0.6mg/hr PO until efficacy or side effects occur (vomiting/diarrhea)
- Continue uric acid-lowering agents if already on prophylactic regimen (do not start)
- Hold diuretic, if on
- Start losaran to replace diuretic (has modest uricosuric effect)
- Alcohol and dietary council
See Also
Source
- Tintinalli