Acute Gout

HISTORY:

‍Severe joint painJoint swelling for ‍ ‍hoursdays

Location: ‍rightleft ‍footgreat toe ‍

‍redness

‍warmth

‍swelling

‍decreased joint movement

‍inability to bear weight

‍fever, up to ‍°, over ‍ ‍hoursdays

‍chills

Worsening factors: ‍none

Treatments tried: ‍none, ‍effectiveineffective



EXAM:

General appearance: ‍well-appearing

Vital signs: ‍normal, BP ‍, HR ‍, RR ‍, SpO2 ‍ %, Temp ‍°

Musculoskeletal: joints ‍ ‍normal, ‍no limited ROM

Foot: ‍rightleft: ‍no tenderness on ‍, range of motion ‍fulllimited

Skin: ‍no rash



ASSESSMENT:

‍Acute gout ‍likelysuspectedpossible

DDx: ‍



PLAN:

- Blood work: ‍CBC, ‍lytes, ‍creatinine, ‍CRP, ‍uric acid

- Joint aspiration

- X-ray

- ‍NSAIDs

- ‍Colchicine

- ‍Corticosteroids

- ‍Allopurinol to start 4 weeks after resolution of acute attack

- Advise to start medication as soon as symptoms start

- Ice packs (advised that may worsen pain in some cases)

- Increase fluid intake

- Avoid high-purine foods, like red meat, shellfish, cheese, and corn syrup

- Avoid alcohol

- Referral to rheumatologist

- Referral to dietician

- Follow-up in ‍ ‍daysweeks

- Return if symptoms worsen or if new symptoms develop such as fever, joint redness, or severe joint pai