Gout

David A. Ross, MD Reviewed 06/2017
 


BASICS

DESCRIPTION

  • Gout is an inflammatory arthritis related to a hyperuricemia (serum uric acid [SUA] level >6.8 mg/dL) 1.

  • Acute gouty arthritis can affect ≥1 joints; the first metatarsophalangeal j...

DIAGNOSIS

HISTORY

  • Classic presentation of acute gouty arthritis:

    • ▪ Intense pain and tenderness in the first metatarsophalangeal joint (podagra)
    • ▪ Can occur in the midtarsal, ankle, or knee joints
    • ▪ Joint ...

TREATMENT

GENERAL MEASURES

Topical ice as needed 5[B

MEDICATION

  • Acute treatment

    • ▪ General principles:
      • * Acute gouty arthritis attacks should be treated with pharmacologic therapy 5[C].
      • * Pharmacologic tre...

ONGOING CARE

FOLLOW-UP RECOMMENDATIONS

Patient Monitoring

  • SUA q2-5wk while titrating urate-lowering treatment to goal 1[C]

  • Regularly monitor CBC, renal function, liver function test, and urinalysis.

DIET

  • G...

REFERENCES

Khanna  D, Fitzgerald  JD, Khanna  PP, et al. 2012 American College of Rheumatology guidelines for management of gout. Part 1: systematic nonpharmacologic and pharmacologic therapeutic app...

CODES

ICD10

  • M10.9 Gout, unspecified

  • M10.00 Idiopathic gout, unspecified site

  • M10.30 Gout due to renal impairment, unspecified site

  • M1A.30X0 Chronic gout due to renal impairment, unsp site, w/o tophus

  • M1A.9...

CLINICAL PEARLS

  • MSU crystals found in synovial fluid aspirate are pathognomonic for gout.

  • Pharmacologic treatment should begin within 24 hours of acute gout flare.

  • Asymptomatic hyperuricemia does not re...

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