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Casebook consults: improving outcomes in gout (multimedia activity).
Am J Med. 2012 Aug; 125(8):S1.AJ

Abstract

Gout is a chronic, potentially debilitating condition characterized by an inflammatory process in the joints or periarticular tissues that results from the deposition of monosodium urate crystals. Underdiagnosis and undertreatment can lead to the development of tophi and chronic arthropathy. A presumptive diagnosis of gout can be made on the basis of the clinical presentation as well as risk factors such as metabolic syndrome. Key conditions to rule out in the differential diagnosis are septic arthritis, calcium pyrophosphate deposition disease (pseudogout), fracture, and rheumatoid arthritis. Acute flares of gout should be managed with nonsteroidal antiinflammatory drugs (NSAIDs), colchicine, or corticosteroids. With a diagnosis of gout, if urate-lowering therapy (ULT) is required, prophylaxis should be considered with low-dose colchicine or an NSAID, followed by the addition of ULT. The goal of ULT is to reach a serum uric acid (SUA) level ≤6.0 mg/dL. Measurements of SUA should be obtained after resolution of an acute attack, then periodically to facilitate titration of the ULT dose to achieve the target SUA level. Studies have confirmed significant reductions in gout attacks among patients who have attained SUA levels ≤6.0 mg/dL with ULT. Patient education concerning the disease and its treatment is essential to ensure close adherence with recommended therapies. Patients should also understand that ULT is intended as long-term, and for most patients, lifelong therapy to maximize the prospects for control of the disease. Clinicians should feel confident in making a presumptive diagnosis and choosing a therapeutic regimen for gout while effectively communicating with and educating patients about their disease.

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Authors+Show Affiliations

Doghramji PP
Ursinus College, Collegeville, Penn., USA.
Mandell BF
No affiliation info available
Pope RS
No affiliation info available

MeSH

Adrenal Cortex HormonesAllopurinolAnti-Inflammatory Agents, Non-SteroidalColchicineFebuxostatGoutGout SuppressantsHumansLong-Term CareMedication AdherenceReferral and ConsultationThiazolesUric Acid

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

22840678

Citation

Doghramji, Paul P., et al. "Casebook Consults: Improving Outcomes in Gout (multimedia Activity)." The American Journal of Medicine, vol. 125, no. 8, 2012, pp. S1.
Doghramji PP, Mandell BF, Pope RS. Casebook consults: improving outcomes in gout (multimedia activity). Am J Med. 2012;125(8):S1.
Doghramji, P. P., Mandell, B. F., & Pope, R. S. (2012). Casebook consults: improving outcomes in gout (multimedia activity). The American Journal of Medicine, 125(8), S1. https://doi.org/10.1016/j.amjmed.2012.06.002
Doghramji PP, Mandell BF, Pope RS. Casebook Consults: Improving Outcomes in Gout (multimedia Activity). Am J Med. 2012;125(8):S1. PubMed PMID: 22840678.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Casebook consults: improving outcomes in gout (multimedia activity). AU - Doghramji,Paul P, AU - Mandell,Brian F, AU - Pope,Richard S, PY - 2012/7/31/entrez PY - 2012/7/31/pubmed PY - 2012/10/2/medline SP - S1 EP - S1 JF - The American journal of medicine JO - Am J Med VL - 125 IS - 8 N2 - Gout is a chronic, potentially debilitating condition characterized by an inflammatory process in the joints or periarticular tissues that results from the deposition of monosodium urate crystals. Underdiagnosis and undertreatment can lead to the development of tophi and chronic arthropathy. A presumptive diagnosis of gout can be made on the basis of the clinical presentation as well as risk factors such as metabolic syndrome. Key conditions to rule out in the differential diagnosis are septic arthritis, calcium pyrophosphate deposition disease (pseudogout), fracture, and rheumatoid arthritis. Acute flares of gout should be managed with nonsteroidal antiinflammatory drugs (NSAIDs), colchicine, or corticosteroids. With a diagnosis of gout, if urate-lowering therapy (ULT) is required, prophylaxis should be considered with low-dose colchicine or an NSAID, followed by the addition of ULT. The goal of ULT is to reach a serum uric acid (SUA) level ≤6.0 mg/dL. Measurements of SUA should be obtained after resolution of an acute attack, then periodically to facilitate titration of the ULT dose to achieve the target SUA level. Studies have confirmed significant reductions in gout attacks among patients who have attained SUA levels ≤6.0 mg/dL with ULT. Patient education concerning the disease and its treatment is essential to ensure close adherence with recommended therapies. Patients should also understand that ULT is intended as long-term, and for most patients, lifelong therapy to maximize the prospects for control of the disease. Clinicians should feel confident in making a presumptive diagnosis and choosing a therapeutic regimen for gout while effectively communicating with and educating patients about their disease. SN - 1555-7162 UR - https://www.unboundmedicine.com/medline/citation/22840678/Casebook_consults:_improving_outcomes_in_gout__multimedia_activity__ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0002-9343(12)00451-2 DB - PRIME DP - Unbound Medicine ER -