Gout and pseudogout: Difference between revisions
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##Colchicine
##Colchicine
###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 one hour later x 1 <ref>Terkeltaub RA et al. High versus low dosing of oral colchicine for early acute gout flare: Twenty-four-hour outcome of the first multicenter, randomized, double-blind, placebo-controlled, parallel-group, dose-comparison colchicine study. Arthritis Rheum. 2010;62(4):1060.<ref>
###1.2mg PO (load), followed by 0.6mg one hour later x 1 <ref>Terkeltaub RA et al. High versus low dosing of oral colchicine for early acute gout flare: Twenty-four-hour outcome of the first multicenter, randomized, double-blind, placebo-controlled, parallel-group, dose-comparison colchicine study. Arthritis Rheum. 2010;62(4):1060.</ref>
###Colchicine should not be administered intravenously
###Colchicine should not be administered intravenously
##Steroids
##Steroids
###Prednisone 30 to 50 mg initially, and gradually tapered over 10 days, results in clinical resolution without rebound pain or complications<ref>Groff GD et al. Systemic steroid therapy for acute gout: a clinical trial and review of the literature. Semin Arthritis Rheum. 1990;19(6):329.</ref><ref>Janssens H. et al. Use of oral prednisolone or naproxen for the treatment of gout arthritis: a double-blind, randomised equivalence trial. Lancet. 2008;371(9627):1854.</ref>
###Prednisone 30 to 50 mg initially, and gradually tapered over 10 days, results in clinical resolution without rebound pain or complications<ref>Groff GD et al. Systemic steroid therapy for acute gout: a clinical trial and review of the literature. Semin Arthritis Rheum. 1990;19(6):329</ref><ref>Janssens H. et al. Use of oral prednisolone or naproxen for the treatment of gout arthritis: a double-blind, randomised equivalence trial. Lancet. 2008;371(9627):1854.</ref>
#All patients
#All patients
##Hold diuretics
##Hold diuretics

Revision as of 02:16, 19 January 2014

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
    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
  2. NSAIDs contra-indicated
    1. 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 one hour later x 1 [1]
      3. Colchicine should not be administered intravenously
    2. Steroids
      1. Prednisone 30 to 50 mg initially, and gradually tapered over 10 days, results in clinical resolution without rebound pain or complications[2][3]
  3. All patients
    1. Hold diuretics
      1. Start losaran to replace diuretic (has modest uricosuric effect)
    2. Alcohol and dietary counseling
    3. Continue uric acid-lowering agents if already on prophylactic regimen (do not start)
    4. Follow up with rheumatoloty
    5. Glucocorticoid injection
      1. 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 joint can coexist with gout.

See Also

Source

  • Tintinalli - Gout
  1. ↑ Terkeltaub RA et al. High versus low dosing of oral colchicine for early acute gout flare: Twenty-four-hour outcome of the first multicenter, randomized, double-blind, placebo-controlled, parallel-group, dose-comparison colchicine study. Arthritis Rheum. 2010;62(4):1060.
  2. ↑ Groff GD et al. Systemic steroid therapy for acute gout: a clinical trial and review of the literature. Semin Arthritis Rheum. 1990;19(6):329
  3. ↑ Janssens H. et al. Use of oral prednisolone or naproxen for the treatment of gout arthritis: a double-blind, randomised equivalence trial. Lancet. 2008;371(9627):1854.
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