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Aug 01, 2021 Issue
Management of Gout: Update from the American College of Rheumatology [Practice Guidelines]
The American College of Rheumatology published updated guidelines for gout management focused on improving prevention of flare-ups.
Risk factors of gout include male sex; obesity; hypertension; alcohol intake; and a diet rich in meat, seafood, and fructose-rich food and beverages. Gout is characterized by swelling, pain, or tenderness in a peripheral joint or bursa. Diagnosis is made using several validated clinical prediction rules. Arthrocentesis should be performed when suspicion for an underlying septic joint is present; synovial fluid or tophus analysis should be performed if the diagnosis is uncertain. Colchicine, nonsteroidal anti-inflammatory drugs, and corticosteroids all relieve pain in acute episodes. Indications for chronic urate-lowering therapy include chronic kidney disease, two or more flares per year, urolithiasis, the presence of tophus, chronic gouty arthritis, and joint damage.
Short-term systemic corticosteroids are frequently prescribed for adults by primary care physicians; however, short courses of the steroids are associated with adverse effects, including hyperglycemia, elevated blood pressure, mood disturbance, sepsis, and fracture. There is evidence against corticosteroid use in patients with acute bronchitis, acute sinusitis, carpal tunnel, and allergic rhinitis and for its use in patients with Bell palsy and acute gout. There is insufficient evidence supporting its use for patients with pharyngitis, lumbar radiculopathy, and herpes zoster.
Nov 1, 2019 Issue
Allopurinol Hypersensitivity Assay HLA-B*58:01 Genotyping [Diagnostic Tests: What Physicians Need to Know]
The allopurinol hypersensitivity assay, or HLA-B*58:01 test, is a blood test to detect the presence of a human leukocyte antigen B (HLA-B) genetic variant that increases the risk of life-threatening, severe cutaneous adverse reactions in patients taking allopurinol.
For patients with gout who require treatment to lower their uric acid level, allopurinol is a safer option than febuxostat.
Lesinurad taken in addition to a xanthine oxidase inhibitor reduces serum uric acid levels. However, it does not reduce the likelihood of experiencing a gout flare-up or completely resolving tophi.
The diagnostic standard for acute gout is joint aspiration with synovial fluid analysis for monosodium urate crystals; however, many patients are seen in a primary care or emergency medicine situation where synovial fluid analysis is rarely performed. The American College of Physicians (ACP) has dev...
What is the accuracy of clinical decision tools and imaging for the diagnosis of gout in the primary care setting, and how effective are medications used to treat and prevent gout?
Gout is ideally diagnosed through identification of characteristic negatively birefringent crystals under polarized light microscopy in fluid aspirated from end-organ deposits, typically from a joint. However, fewer than 10% of patients with gout see a rheumatologist, and most cases of gout are diag...
Thiazide diuretics may be used in most patients with hypertension who have only minimally increased risk of gout.