SHM's Clinical Quick Talks-Acute Gout Flare Management for Hospitalist

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Acute gout is a painful condition that affects approximately 3% of adults in the US. It is more common in men than in women. Risk factors for developing gout include increasing age, alcohol consumption, a high purine diet (such as seafood and red meat), fructose consumption, chronic kidney disease, and certain medications. Acute gout can be triggered by hospitalization, myocardial infarction, trauma, or sepsis.<br /><br />Symptoms of acute gout include sudden onset of pain, redness, and swelling in one or a few joints. The most commonly affected joint is the first metatarsophalangeal joint, but other joints such as ankles, knees, hands, and wrists can also be involved. Signs of acute gout include hot, swollen, and tender joints. Tophi, which are deposits of urate crystals, may be present in soft tissues. In some cases, gout can mimic infectious cellulitis.<br /><br />To diagnose acute gout, a synovial fluid analysis is performed through arthrocentesis. The presence of needle-shaped, negatively birefringent crystals indicates gout, while positively birefringent, rhomboid-shaped crystals indicate calcium pyrophosphate deposition disease. White blood cell count in the synovial fluid can help differentiate between noninflammatory and inflammatory conditions. Additional tests such as a complete blood count and metabolic panel may be done to assess overall health.<br /><br />Treatment options for acute gout include nonsteroidal anti-inflammatory drugs (NSAIDs), colchicine, steroids, and anakinra. The choice of treatment depends on patient factors. NSAIDs like indomethacin or naproxen can be used for a limited time, but caution is needed in certain patients. Colchicine can be effective if taken early in the attack, while steroids can be given systemically or directly into the affected joint. Anakinra is an option when other treatments are contraindicated.<br /><br />After acute treatment, lifestyle modifications are recommended, such as avoiding alcohol, high fructose beverages, and purine-rich foods. Switching medications (such as hydrochlorothiazide) to alternative options may be considered.<br /><br />In summary, acute gout is a common and painful condition that primarily affects men. Prompt diagnosis and appropriate treatment can relieve symptoms and prevent complications. Lifestyle changes and ongoing management may be needed to prevent future gout attacks.

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Allison Schue, Sonam Kiwalkar

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Concept Gout

Concept Septic Arthritis

Concept Arthrocentesis

Concept Clinical Presentation

Concept Differential Diagnosis

Keywords

acute gout

painful condition

men

joints

symptoms

diagnosis

treatment options

lifestyle modifications

prevent complications

ongoing management

Gout

Septic Arthritis

Arthrocentesis

Clinical Presentation

Differential Diagnosis