[Gout and its differential diagnosis]

Area of Science:

• Rheumatology
• Orthopedics
• Internal Medicine

Background:

• Arthritis urica (gout) is a prevalent form of arthritis in Switzerland.
• It can present similarly to septic arthritis and may lead to chronic polyarticular disease.
• Clinical suspicion arises from patient age, sex, and initial presentation, but diagnosis requires confirmation.

Purpose of the Study:

• To highlight the diagnostic challenges and therapeutic strategies for arthritis urica.
• To emphasize the role of synovial fluid analysis and functional ultrasound in diagnosis.
• To outline immediate and long-term management approaches for gout.

Main Methods:

• Microscopic analysis of synovial fluid for definitive diagnosis.
• Functional ultrasound-guided aspiration of synovial fluid from small joints.
• Intra-articular injection of crystalline glucocorticoids and local anesthetics.
• Initiation of immediate maximal-dose non-steroidal anti-inflammatory drugs (NSAIDs) or Cox-2 inhibitors.
• Administration of moderate-dose glucocorticoids for a short duration.

Main Results:

• Functional ultrasound facilitates accurate diagnosis by enabling fluid collection from small joints.
• Intra-articular injections provide prompt pain relief and interrupt inflammation.
• Early and aggressive use of NSAIDs and short-term glucocorticoids are key treatment components.
• Normalization of serum uric acid levels is crucial for preventing recurrent gout attacks.

Conclusions:

• Arthritis urica requires prompt diagnosis, often aided by functional ultrasound.
• A multimodal treatment approach including intra-articular injections, NSAIDs, and glucocorticoids is effective.
• Long-term management focusing on serum uric acid normalization is essential for preventing recurrence.