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Gout/Pseudogout, Emergency Medicine

Reviewed 06/2017
 


Basics

Description

  • Uric acid deposition into tissues, affecting mainly middle-aged men and postmenopausal women:

    • Most common crystalline diseases

    • 4 phases:

      • Asymptomatic hyperuricemia (serum urate >7 mg...

Diagnosis

Signs and Symptoms

  • Gout and pseudogout both present as acute monoarticular or polyarticular arthritis:

    • Increased warmth, erythema, and joint swelling are present.

    • Early attacks subside spontane...

Treatment

Initial Stabilization/Therapy

  • Relieve pain.

  • Rule out infectious cause.

Ed Treatment/Procedures

  • NSAIDs are 1st-line treatment.

  • If NSAIDS ineffective or contraindicated:

    • Steroids (oral, intravascula...

Follow-Up

Disposition

Admission Criteria

  • Suspected infectious arthritis

  • Acute renal failure

  • Intractable pain

Discharge Criteria

  • No evidence of infection

  • Adequate pain relief

Issues for Referral

  • Septic arthriti...

Pearls and Pitfalls

  • Septic arthritis can occur simultaneously with an acute gout attack.

  • NSAIDs are 1st-line treatment if tolerated.

  • Attacks generally tend to be self-limited.

  • Gout and pseudogout can lea...

Additional Reading

  • Crittenden  DB, Pillinger  MH. New therapies for gout. Annu Rev Med.  2013;64:325–337.

  • Laubscher  T, Dumont  Z, Regier  L, et al. Taking the stress out of managing gout. Can Fam...

Codes

ICD9

  • 274.00 Gouty arthropathy, unspecified

  • 274.9 Gout, unspecified

  • 712.30 Chondrocalcinosis, unspecified, site unspecified

  • 712.37 Chondrocalcinosis, unspecified, ankle and foot

  • 712.33 Chondrocalcinos...

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