CCS Acute Gout Attack

Step 1

• Keep foot elevated

Birefringence microscopy of gout, annotated

Step 2

Labs: CBC, sma7, Uric acid, Stool guaiac test, UA with microsynovial fluid for light polarising micrograph.C&S ,Gram stain,glucose,protein,cell count.

24 hour urine for UA

Step 3

X-ray of the joint.

Step 4

Diet:low purine

Step 4

Medications:Motrin PO or Indomethacin Po for 2 days, then hypouricemic therapy:Probenicid increase until UA level falls below 6.5. Allopuinol, after attack.

Step 5

symptomatic care:Ranitidine bid. Meperidine or Vicodine

Step 6

Counseling: Counsel patient on low purine load diet

---

More on Gout

History of Gout! Perhaps the oldest known type of arthritis, gout or gouty arthritis has been described since Hippocrates in the 5th century B.C. Known as the “Disease of Kings” due to its association with rich foods and alcohol consumption, colorful depictions of gout can be found in art and literature often with commentary on the moral character of the gout sufferer.

Acute Gout

Gout is caused by a defect in metabolism that results in an overproduction of uric acid, or a reduced ability of the kidney to eliminate uric acid. The exact cause of the metabolic defect is unknown. The condition may also develop in people with diabetes, obesity, sickle cell anemia, and kidney disease, or it may follow drug therapy that interferes with uric acid excretion.

Gout has 4 stages: asymptomatic (without symptoms), acute, intercritical, and chronic.

In acute gouty arthritis, symptoms develop suddenly and usually involve only one or a few joints. The pain frequently starts during the night and is often described as throbbing, crushing, or excruciating. The joint appears infected with signs of warmth, redness, and tenderness.

The attacks of painful joints may subside in several days, but may recur at irregular intervals. Subsequent attacks usually have a longer duration. Some people may progress to chronic gouty arthritis, while others may have no further attacks.

The risk is greater in men, postmenopausal women, and people who use alcohol.

Symptoms

• Joint pain
• Begins suddenly
• Affects one or more joints (hip pain, knee pain, ankle pain, foot pain, shoulder pain, elbow pain, wrist pain, hand pain, or pain in other joints)
• The great toe, knee, or ankle joints are most often affected
• Joint swelling of the affected joints
• Stiffness of the joint
• The joint may be warm and red
• Fever may be present
• Skin lump which may drain chalky material

Signs and tests

• A physical examination of the joints shows acute arthritis.
• Synovial fluid analysis shows uric acid crystals.
• Uric acid (blood test) may be elevated.
• Joint X-rays may be normal.

The following tests might also be helpful:

• Uric acid - urine
• Synovial biopsy

Treatment

• The goals of treatment are mainly to stop the pain and inflammation associated with the initial attack, and to prevent future attacks.

• Colchicine is one of the medications that is effective in reducing the pain, swelling, and inflammation associated with acute gout attacks. The pain often subsides within 12 hours of starting treatment, and is completely relieved in 48 hours.

• The medication works by decreasing the inflammation caused by uric acid crystals within the joint. However, it does not decrease the uric acid levels in the bloodstream. Daily use of colchicine or allopurinol helps prevent future attacks.

• Non-steroidal anti-inflammatory drugs - NSAIDs can be very effective in treating the pain and inflammation of an acute gout attack if taken soon after symptoms start.

• Corticosteroids can also be very effective. Your doctor may inject the inflamed joint with steroids to relieve the pain.

• Codeine or other analgesics may occasionally be prescribed for pain relief. Increased fluid intake prevents the formation of kidney stones.

• Sometimes, a diet low in purines is prescribed. Organ meats, beer, wine, and certain types of fish contain high levels of purines.

This article is a stub. You can help WikiMD by registering to expand it. Editing is available only to registered and verified users. WikiMD is a comprehensive, free health & wellness encyclopedia.

USMLE Wiki

• Usmle Step1 | Usmle Step2 | Usmle Step3

• List of Cases > CSA&CS | Step3CCS

Popular: Usmle Step 3 CCS | Usmle Step 3 CCS cases part 2 - over 70 solved cases

Asters Notes > Asters Notes I | Asters Notes II | Asters Notes III

Other resources: Usmle Q Banks | Residency Wiki

List of patient cases