Gout
(& Pseudogout, Inflammatory Arthritis)
Gout
(& Pseudogout, Inflammatory Arthritis)
Patients with monoarticular or polyarticular gout or pseudogout
Mild RA and other inflammatory arthritis flares also included
Must be proven by arthrocentesis, or have had prior flares diagnosed with synovial fluid analysis
Ongoing concern for septic arthritis
Synovial fluid with >50,000 WBC. Use caution in patients with WBC > 25k
Positive Gram Stain, Fever > 101
Serial (q8h) examinations
Medications
NSAID if GFR > 30
Oral or IV Steroids
Colchicine 1.2 mg, followed by 0.6 mg on day one, 1.2 mg daily subsequently
Intra-Articular Injections
Steroid in joint for Monoarticular presentations (dexamethasone, triamcinolone, methylprednisolone)
Physical Therapy Consult if patient has questionable return to home status after 18 hours of treatment.
Disposition
Symptoms improved or improving
Normal Vital Signs
Ambulatory at at baseline level of function
Follow up plan established
Unstable vital signs or worsening clinical condition
Significant lab or imaging abnormalities
Complications of injection of steroid therapy noted
Patient unable to ambulate
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