Gout and pseudogout: Difference between revisions
| Line 21: | Line 21: | ||
==Treatment== | ==Treatment== | ||
#NSAIDs NOT contra-indicated | #NSAIDs NOT contra-indicated | ||
##Do not give to pts w/ renal insufficiency (use opioids instead) | ##Do not give to pts w/ renal insufficiency (use opioids instead) | ||
##Substantial pain relief should occur within 2hr | ##Substantial pain relief should occur within 2hr | ||
##Options | ##Options: | ||
###Indomethacin 50mg po TID x3-5d, OR | ###Indomethacin 50mg po TID x3-5d, OR | ||
###Ibuprofen 800mg PO TID x 3-5d | ###Ibuprofen 800mg PO TID x 3-5d | ||
| Line 31: | Line 30: | ||
##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) | ||
#All | #All patients | ||
#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) | ||
#Alcohol and dietary council | ##Alcohol and dietary council | ||
#Continue uric acid-lowering agents if already on prophylactic regimen (do not start) | ##Continue uric acid-lowering agents if already on prophylactic regimen (do not start) | ||
#Follow up with rheumatoloty | ##Follow up with rheumatoloty | ||
==See Also== | ==See Also== | ||
Revision as of 05:11, 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 NOT contra-indicated
- Do not give to pts w/ renal insufficiency (use opioids instead)
- Substantial pain relief should occur within 2hr
- Options:
- Indomethacin 50mg po TID x3-5d, OR
- Ibuprofen 800mg PO TID x 3-5d
- NSAIDs contra-indicated
- 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)
- All patients
- Hold diuretic, if on
- Start losaran to replace diuretic (has modest uricosuric effect)
- Alcohol and dietary council
- Continue uric acid-lowering agents if already on prophylactic regimen (do not start)
- Follow up with rheumatoloty
- Hold diuretic, if on
See Also
Source
- Tintinalli