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Gout

David A. Ross, MD, CAQSM Reviewed 06/2020
 


BASICS

DESCRIPTION

  • Gout is an inflammatory arthritis characterized by deposition of monosodium urate (MSU) crystals that accumulate in joints and soft tissues, resulting in acute and chronic arthritis,...

DIAGNOSIS

HISTORY

  • Classic presentation of acute gouty arthritis:

    • Intense pain and tenderness in the 1st metatarsophalangeal joint (podagra)

    • Can occur in the midtarsal, ankle, or knee joints

    • Joint may be s...

TREATMENT

GENERAL MEASURES

Topical ice or cold pack as needed (5)[B

MEDICATION

  • Acute treatment

    • General principles:

      • Acute gouty arthritis attacks should be treated with pharmacologic therapy (5)[C].

      • Pharma...

ONGOING CARE

Recommended regular follow-up with primary care physician or rheumatologist during acute gout flare 

FOLLOW-UP RECOMMENDATIONS

Patient Monitoring

  • Serum uric acid measurements q2–5wk while ti...

REFERENCES

1
Khanna D, Fitzgerald JD, Khanna PP, et al; for American College of Rheumatology. 2012 American College of Rheumatology guidelines for management of gout. Part 1: systematic nonpharmacologi...

ADDITIONAL READING

Neogi T, Jansen T, Dalbeth N, et al. 2015 Gout classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative. Arthritis Rh...

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

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

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

  • Asymptomatic hyperuricemi...

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