Gout and pseudogout

Pathophysiology

• Primarily an illness of middle-aged and elderly adults
• 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
• Constitutional symptoms

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

Acute

1. NSAIDs
   1. Do not give to pts w/ renal insufficiency (use opioids instead)
   2. Substantial pain relief should occur within 2hr
   3. Indomethacin 50mg po TID x3-5d
2. Colchicine
   1. Can be used as alternative agent to NSAIDs in pt w/ normal renal/hepatic function
   2. 0.6mg/hr PO until efficacy or side effects occur (vomiting/diarrhea)

See Also

• Monoarticular Arthritis

Source

• Tintinalli