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Tuesday, April 26, 2022

Gout

emDOCs - April 25, 2022, By Shannon M. Burke and Benjamin H. Schnapp
Reviewed by: Michael J. Yoo, Alex Koyfman and Brit Long

                            
Key Points:
  • It’s possible to diagnose acute gout flares clinically, but the gold standard is arthrocentesis. Use this whenever there is concern for a septic joint or if the clinical picture is not entirely consistent with an acute gout flare.
  • Treatment of gout is anti-inflammatory medications, and this mostly means NSAIDs, corticosteroids, and colchicine.
    • Avoid the combination of NSAIDs and corticosteroids due to additive GI toxicity.
    • Remember there are contraindications to these medications. Pay attention to a patient’s kidney function, liver function, and history of diabetes.
    • Certain patients may also be eligible for initiation of urate-lowering therapy even in an acute gout flare.
  • Opioids are not a first-line treatment for gout, although they may be used if there are significant contraindicationsto anti-inflammatory medications.