Management of Acute Gout.pptVIP

Management of Acute Gout John J. Cush, MD Presbyterian Hospital of Dallas Who Manages Acute Gout Rheumatologists:musculoskeletal medicine specialists Tends to see minority of Gout patients, often those with severe, recalcitrant, chronic disease Compared with RA (similar prevalence), far fewer gout patients are seen/followed by rheumatologists Rheum referral more accurate dx, shorter Sx duration (3.1day), shorter hospitalization (7.4 days), lower hospitalization costs ($5995 less). Solomon DH. Ann Int Med 12:52, 1997 Primary Care and Emergency Dept Physicians First line for acute gouty attacks Education is needed to optimize outcomes and limit toxicity Survey in Mexico shows significant drug misuse by non-rheumatologists (GP,IntMed,Ortho) Rev Invest Clin 55:621,2003 Survey of N.Zealand Rheums and GPs: differences in NSAID, colchicine, allopurinol use. Stuart RD N Z Med J 104:115,1991 Gout Disorder of urate metabolism, results in deposition of monosodium urate (MSU) crystals in joints and soft tissues. 1st described 5th century BC – Hippocrates described gout as “the king of diseases and the disease of kings” Burden: In 1981, 37 million lost work days in US* 2003 Kim et al estimates the annaul cost of Acute Gout is $27,378,494 in the USA (underestimate: women excluded not all indirect and intangible costs included) Prevalence of Gout Gout Acute: intermittent/recurrent, LE, ascending, inflammatory mono/oligoarthritis, “Podagra” Intercritical gout: between attacks Tophaceous gout: chronic, accumulation of MSU crystals as “tophi” (may look like RA) Asymptomatic hyperuricema: elevated uric acid without evidence of gout, nephrolithiasis. Higher levels increase risk of these diseases Renal: nephrolithiasis, gouty nephropathy, uric acid nephropathy Acute (Classic) Gout Acute, severe onset of pain, warmth, inflammation, Limited motion ? cant walk, cant put sheet on it. Podagra (50-90%): pain, swelling warmth in 1st MTP Joints: MTP, tarsus, ankle, knee Associated with feve