Info
gout
Diagnosis
- ↑ UrA is → not diagnostic; 25% of measurements nl during flare; ± ↑ WBC & ESR
- Arthrocentesis is → gold standard: intracellular negatively birefringent needle-shaped MSU crystal. U/S w/ double-contour sign or dual-energy CT can aid non-invasive dx.
- 2015 ACR/EULAR Classification Criteria (Ann Rheum Dis 2015;74:1789) used 1° in research
Acute treatment (Arthritis Care Res 2020;72:744)
- Colchinine, NSAIDs, & steroids all 1st-line; choice guided by side effect profile/comorbidities.
- IL-1i (J Rheum 2019;46:1345) or ACTH if these contraindicated.
- Start Rx ASAP;
- continue until acute flare resolves;
- consider combo Rx if severe;
- rest/ice;
- self-limited w/in 3-21+ d w/o Rx.
- Continue urate-lowering therapy during attack if already taking
- Table-Acute Treatment for Gout
Chronic treatment
- Approach:
- if ≥2 attacks/y, polyarticular attack, tophus, joint erosions, GFR <60, or urolithiasis
- → start urate-lowering therapy + pharmacologic Ppx
- to ↓ risk of acute attacks
- Urate-Lowering Therapy (Chronic Treatment for Gout)
- goal UrA <6 mg/dL;
- when starting ULT, always give with pharm Ppx as below;
- do NOT d/c during acute attack or due to AKI
- Pharmacologic prophylaxis: continue 6 mos w/ above Rx or longer if frequent attacks:
- low-dose colchicine (~50% ↓ risk of acute flare; J Rheum 2004;31:2429),
- NSAIDs (less evidence; Ann Rheum Dis 2006;65:1312),
- low-dose steroids,
- IL-1 inhibitors
- Lifestyle Δs:
- ↓ intake of meat,
- EtOH,
- & seafood,
- ↑ low-fat dairy,
- wt loss,
- avoid dehydration