7 responses to “Part 1: Diagnosing Gout in Primary Care Settings: Do we have to tap?”

  1. Thanks for a succinct summary.
    Is radiography indicated at all?

  2. Are patients on hydrochorthiazide more likely to get gout. I thought so and I try to get my patients off diuretics before putting them on allopurinol. Does this make sense.

  3. I have been using dual energy CT of the affected joint to demonstrate urate crystals if present.

  4. I relied on history given by patients, by clinical signs and symptoms
    to make a diagnosis and offer and immediate treatement with good
    relief of pain and swelling.
    I ordered CBC,KFT’s,uric acid and other related health profile.
    Thank you for your succinct summary.

  5. Thanks! That was very helpful. Is the serum uric acid level referring to a level during the current event or a prior level? I would hesitate to wait for a result in 24-48h to make a decision using the tool.

  6. Thank you for everyone’s comments. Please see responses below.
    1. Radiographic X-Ray findings are often found years later in the disease, and are often normal in patients with initial attack. In those that have X-Ray findings, tophi as well as punched out erosions may be seen.
    2. You are absolutely right. Hydrochlorothiazide can increase serum uric acid levels, and lead to gout. If there are no specific indications for treatment of hypertension, HCZ may be substituted by another agent for treatment of hypertension. However, guidelines do not strongly recommend discontinuation of HCZ in patients with gout.
    3. Yes. You are correct. Advent of Dual Energy CT in the recent years has provided a powerful tool in identifying urate crystals in patients with gout, especially in those who present atypically, or with history of attacks. However, there can be a delay in obtaining in these scans, and therefore in the outpatient settings, their use may be limited in an acute attack.
    4. Any uric acid level may be used (previous or current – whichever is higher)

    Dr. Kam Shojania & Neda Amiri

  7. I like this approach. One limitation is the getting the uric acid level in timely manner as direction of investigations and likelihood of diagnosis is highly dependant on that (has 3.5 weight).

    If using colchicine does this approach require waiting for results of uric acid before commencing treatment? (Ie use NSAIDs as bridge).

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