eMedicine Specialties > Rheumatology > Crystal-Induced Arthritis

Gout: Follow-up

Author: Anne V Miller, MD, Assistant Professor of Medicine, Division of Rheumatology, Southern Illinois University School of Medicine
Coauthor(s): Sriya K M Ranatunga, MD, MPH,, Assistant Professor, Department of Clinical Medicine, Southern Illinois University School of Medicine; Mark L Francis, MD, Chief, Associate Professor, Department of Internal Medicine, Division of Rheumatology, Southern Illinois University School of Medicine
Contributor Information and Disclosures

Updated: Feb 20, 2009

Follow-up

Further Outpatient Care

After diagnosis and treatment of an acute gouty arthritis episode, the patient should return for a follow-up visit in approximately 1 month to be evaluated for therapy to lower serum uric acid levels. If uric acid–lowering therapy is begun, patients should be seen every 1-2 months while adjusting the dose of medications to achieve the target uric acid level of 5-6 mg/dL. Once this level is achieved and maintained, patients can be seen every 6-12 months.

Deterrence/Prevention

  • Avoiding alcohol (beer and hard liquor) and avoiding obesity may help deter or prevent gout.

Complications

  • Although effective treatments for gout exist, failure of control can occur with inadequate dosing of urate-lowering medication, generally as a consequence of delayed treatment, inadequate serum urate goals, patient noncompliance, and/or medication intolerance.
  • Untreated gout can lead to severe joint destruction and renal impairment.
  • Septic arthritis can occur in a gouty joint, and draining tophi can become secondarily infected.

Prognosis

  • Gout that is treated early and properly carries an excellent prognosis if patient compliance is good.

Patient Education

  • Online information and pamphlets on gout are available from the Arthritis Foundation. If appropriate, patients should be counseled on the use of alcohol and a low-fat diet.
  • For excellent patient education resources, visit eMedicine's Arthritis Center. Also, see eMedicine's patient education article Gout.

Miscellaneous

Medicolegal Pitfalls

  • The major pitfall associated with gout is not establishing a crystal diagnosis. Establishing a crystal diagnosis is relatively easy and provides a clear reason to use life-long medications, such as allopurinol, which have potentially serious adverse effects.
  • Patients who present with acute inflammatory arthritis need to undergo arthrocentesis to exclude septic arthritis, even if their serum uric acid level is elevated. Nongonococcal infectious arthritis carries a 10% fatality rate and therefore must be excluded.
  • Under normal circumstances, patients should not be treated indefinitely with colchicine monotherapy. Synovial tophi will continue to grow and disrupt cartilage and bone. To prevent recurrent flares and tophus formation, patients should be given an agent that lowers uric acid, unless a contraindication exists.
  • Do not start therapy with an agent that lowers uric acid during the acute attack because doing so may intensify and prolong the attack.
  • Colchicine, even in prophylactic doses, can cause marrow toxicity and neuromyopathy in the setting of renal insufficiency.
 


More on Gout

Overview: Gout
Differential Diagnoses & Workup: Gout
Treatment & Medication: Gout
Follow-up: Gout
Multimedia: Gout
References
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References

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Further Reading

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Keywords

gout, uric acid metabolism, chronic tophaceous gout, tophaceous gout, gouty arthritis, primary gout, secondary gout, acute gout, chronic gout, pseudogout, polyarticular gout, saturnine gout, hyperuricemia, cyclosporin A, acute monoarticular arthritis, podagra, polyarticular arthritis, uric acid, inflammasome, anakinra, interleukin 1, joint inflammation, joint destruction

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Contributor Information and Disclosures

Author

Anne V Miller, MD, Assistant Professor of Medicine, Division of Rheumatology, Southern Illinois University School of Medicine
Anne V Miller, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, American College of Rheumatology, and International Society for Clinical Densitometry
Disclosure: Nothing to disclose.

Coauthor(s)

Sriya K M Ranatunga, MD, MPH,, Assistant Professor, Department of Clinical Medicine, Southern Illinois University School of Medicine
Disclosure: Nothing to disclose.

Mark L Francis, MD, Chief, Associate Professor, Department of Internal Medicine, Division of Rheumatology, Southern Illinois University School of Medicine
Mark L Francis, MD is a member of the following medical societies: American Association of Immunologists, American College of Physicians, American College of Rheumatology, American Medical Association, Illinois State Medical Society, and Phi Beta Kappa
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Lawrence H Brent, MD, Associate Professor of Medicine, Thomas Jefferson University; Chair, Program Director, Department of Medicine, Division of Rheumatology, Albert Einstein Medical Center
Lawrence H Brent, MD is a member of the following medical societies: American Association for the Advancement of Science, American Association of Immunologists, American College of Physicians, and American College of Rheumatology
Disclosure: Genentech Honoraria Speaking and teaching; Genentech Grant/research funds Other; Amgen Honoraria Speaking and teaching; Wyeth Honoraria Speaking and teaching; Abbott Immunology Honoraria Speaking and teaching; Takeda Honoraria Speaking and teaching; UCB  Speaking and teaching; Omnicare Consulting fee Consulting; Centocor Consulting fee Consulting; Roche Grant/research funds Other

CME Editor

Alex J Mechaber, MD, FACP, Associate Dean for Undergraduate Medical Education, Associate Professor of Medicine, University of Miami Miller School of Medicine
Alex J Mechaber, MD, FACP is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians-American Society of Internal Medicine, and Society of General Internal Medicine
Disclosure: Nothing to disclose.

Chief Editor

Herbert S Diamond, MD, Professor of Medicine, Temple University School of Medicine; Chairman Emeritus, Department of Internal Medicine, Western Pennsylvania Hospital
Herbert S Diamond, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, American College of Rheumatology, American Medical Association, and Phi Beta Kappa
Disclosure: medifocus Honoraria Review panel membership; health dialogs Honoraria Consulting; West Penn Allegheny Health System None Board membership

 
 
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