As always, this is from the ever expanding google doc on bits and bobs I read and learn from and transfer here for all our learning pleasure. This one from a recent training day with a rheumatologist. Some is literature based some his good old fashioned doctoring and experience.
- 10-40% have a normal urate during flares
- the red hot shiny joint is rarely rheumatoid, much more suggestive of gout
- 95% of nodules are gout or rheumatoid. If you want a really easy diagnosis then crystals of gout are present in huge numbers in a gouty tophus and if you can read or find someone to read a microscope then it might get you out of needling a joint
- wine less gout forming than beer or spirit
- coffee protective against gout
- intense exercise and micro trauma at 1st MTP can precipitate gout
- podagra was the old school term for classic 1st MTP disease. Knee disease rejoices in the term gonagra
Acute treatment pearls:
- NSAIDs, if contraindications then topical still great for single joint
- Colchicine (1.8mg a day) at a low dose, can be used chronically. Remember SEs (sepsis, home marrow suppression. Mostly D&V)
- Steroids (personally i use steroids a lot for gout in the older folk with comorbidities and a few joints involved)
Chronic treatment pearls:
- Colchincine can be used
- Allopurinol: usually wait 6 weeks but can start immediately as long as they get some steroid cover which was news to me
References:
- Excellent rheumatology lecture somewhere in the midlands of Ireland Spring 2015
- Featured Image: Nick Gorton, CC License, Wikipedia
Other FOAMed sources