Treating and Preventing Acute Gout Attacks


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Treating and Preventing Acute Gout Attacks

Acute Polyarthritis


Question 1

c.  Correct.

Evaluation of the synovial fluid under polarizing light microscopy for the presence of urate and/or calcium pyrophosphate dihydrate (CPPD) crystals is an important component of the diagnostic evaluation of acute inflammatory polyarthritis, as is Gram staining and culture of the synovial fluid to exclude infection. Although septic arthritis usually causes monoarticular arthritis, polyarticular septic arthritis occurs, particularly from streptococcal infection. Identification of urate crystals in the synovial fluid will distinguish gout from CPPD-associated arthritis (pseudogout).

Gout can present as polyarticular disease, even in a patientís initial attack. Some series have suggested that this may occur more often in women than in men.1,2

Rheumatoid arthritis more commonly presents with an insidious chronic course; its onset may be acute, but other causes of acute polyarthritis need to be excluded. Although approximately 80% of patients with rheumatoid arthritis have a positive serum rheumatoid factor test, rheumatoid factor is not diagnostic for rheumatoid arthritis, as it can also be present in other forms of acute polyarthritis, including the arthritis of hepatitis C.

Serum urate is usually elevated in patients with gout, but its level may be normal, low, or high during an acute gout attack and thus has low sensitivity and specificity for the diagnosis of gout. The serum urate level should not be used to confirm or exclude the diagnosis of acute gout.

Radiographs are not likely to assist in confirming a diagnosis in the acute setting, as radiographs and other imaging studies will not distinguish acute infectious from acute crystal-induced arthritis.