Gout and pseudogout

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

1. NSAIDs NOT contra-indicated
2. NSAIDs
   1. Do not give to pts w/ renal insufficiency (use opioids instead)
   2. Substantial pain relief should occur within 2hr
   3. Options
      1. Indomethacin 50mg po TID x3-5d, OR
      2. Ibuprofen 800mg PO TID x 3-5d
3. NSAIDs contra-indicated
4. Colchicine
   1. Can be used as alternative agent to NSAIDs in pt w/ normal renal/hepatic function
   2. 1.2mg PO (load), followed by 0.6mg/hr PO until efficacy or side effects occur (vomiting/diarrhea)
5. All
6. Hold diuretic, if on
   1. Start losaran to replace diuretic (has modest uricosuric effect)
7. Alcohol and dietary council
8. Continue uric acid-lowering agents if already on prophylactic regimen (do not start)
9. Follow up with rheumatoloty

See Also

• Joint Pain
• Monoarticular Arthritis

Source

• Tintinalli