Primary Diagnosis- Gout
A form of inflammatory arthritis that is characterized by painful inflammation of the joints, primarily the first MTP joint, but can also be seen in the fingers, wrists, knees, elbows and ankles. The accumulation of monosodium urate crystals in the joint area causes the af...
, • CPT code 89060- Crystal identification by light microscopy with or without polarizing
lens analysis, tissue, or any body fluid.
Guidelines- 2020 American College of Rheumatology Guideline for the Management of Gout
(FitzGerald et al., 2020) (American College of Rheumatology, 2023).
1. Treatment of acute gout episode- Pharmacological- Nonsteroidal anti-inflammatory drugs
(NSAIDs), corticosteroids, or colchicine, are recommended first-line treatments for gout
flare-ups (FitzGerald et al., 2020).
• NSAID- Naproxen 500mg po bid with food, x 7 days, #30, for pain and
inflammation, monitor for bleeding, ulcers. Reduce to Naproxen 250mg bid for
prophylaxis for 3-6 months.
• Corticosteroid -Prednisone 10mg tabs, 3 tabs (30mg) po qd with food x 5 days,
#15, for inflammation- monitor for mood changes, elevated BP.
• Colchicine – 0.6mg, 2 tabs (1.2mg) po x 1 followed by one tab (0.6mg) po after
one-hour, #3, – monitor for n/v/diarrhea, avoid grapefruit products. Reduce to
colchicine 0.5mg po qd for prophylaxis for 3-6 months.
• Management to prevent recurrent flare-ups
o Start allopurinol to prevent flare-ups 2-3 weeks after acute attack (American
College of Rheumatology, 2023). Allopurinol 100mg, one po qd, incr. 100
mg/day q2wks until uric acid <6 mg/dL, #45. Take with a full glass of water,
take with food if upset stomach. Monitor kidney and liver function, monitor
for painful rash,(Stevens-Johnson Syndrome), bloody urine, signs of infection,
and liver problems.
2. Non-Pharmacological (American College of Rheumatology, 2023).
• Low purine diet, decrease consumption of red meat, seafood
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