Diagnosis and management of acute gout

A definitive diagnosis of acute gout is made by detection of monosodium urate crystals in the synovial fluid of an inflamed joint. However, when this is not feasible a clinical diagnosis can sometimes be made with reasonable accuracy. The mainstays of acute gout management are colchicine, NSAIDs, and systemic or intra-articular corticosteroids. NSAIDs are preferable to colchicine because of their more favorable side effect profile. Successful treatment occurs with the prompt initiation of high dose short half-life NSAIDS. Since many patients with gout have comorbidites that preclude the use of NSAIDS or colchicine, systemic corticosteroids are commonly used to treat acute gouty arthritis. Intra-articular injections are appropriate in the setting of mono- or oligoarticular involvement. Adequate duration of anti-inflammatory therapy and careful patient education are essential elements of successful therapy for acute gout. Evaluation and management of hyperuricemia should be undertaken when all symptoms of acute gout are resolved and the patient is stable on daily prophylaxis with NSAIDs or colchicine.