Gout and Pseudogout Questions & Answers

Updated: Jul 26, 2019
  • Author: Bruce M Rothschild, MD; Chief Editor: Herbert S Diamond, MD  more...
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Questions & Answers

Overview

What is the difference between gout and pseudogout?

What are the symptoms of gout and pseudogout?

What are the physical findings of gout and pseudogout?

What are the complications of gout?

Which studies may be helpful in the diagnosis of gout and pseudogout?

What are the typical characteristics of erosions in gout?

Which ultrasonographic findings indicate gout?

Other than ultrasonography, which imaging studies are used to evaluate gout?

How is gout managed?

What agents are used in the treatment of acute crystal-induced arthritis in gout?

Which agents are used to lower uric acid levels in gout?

Which therapeutic agents may be considered in the treatment of gout?

What dietary changes may be beneficial in the treatment of gout and pseudogout?

What are gout and pseudogout?

What are the likely complications if gout is left untreated?

What are the risk factors for developing gout?

What is the difference between primary and secondary gout?

How is gout diagnosed?

What is the prognosis of gout?

How are gout and pseudogout managed?

What is the pathogenesis of gout?

What is the pathogenesis of pseudogout?

Where are urate crystals found in patients with gout?

What triggers a gout attack?

How does gout develop?

Why do excess urate stores develop in gout?

What causes secondary gout due to underexcretion of uric acid?

What comorbid conditions increase the risk of developing gout?

Which foods increase the risk of gout?

Is gout a genetic disorder?

Which genes are associated with an increased risk of gout?

What are the major causes of gout in developed countries?

What triggers gout flares?

How do the underlying causes of gout and pseudogout differ?

What are the risk factors for development of pseudogout?

What genetic or environmental factors are responsible for pseudogout?

What is the prevalence of gout in the US?

At what age does pseudogout become increasingly common?

Are gout attacks seasonal?

What is the global prevalence of gout?

Are gout and pseudogout more common in men or women?

How does the prevalence of gout differ among age groups?

What causes early onset of gout?

Does gout have a racial predilection?

What is the general prognosis of gout?

What is the prognosis of gout with early treatment?

What is the prognosis of untreated chronic tophaceous gout?

What is the prognosis of acute attacks of pseudogout?

Which diseases are associated with hyperuricemia and gout?

Are mortality rates increased in patients with gout?

Are vascular or cardiovascular risk increased in patients with gout?

What dietary restrictions are advisable for gout?

Presentation

What medical history indicates gout?

Where are the most common sites of gout arthritis?

Where are the most common sites of pseudogout arthritis?

Can gout and pseudogout be polyarticular?

How long do symptoms of untreated acute gout last?

How often does gout initially present as polyarticular arthritis?

Do the symptoms of untreated gout change over time?

What triggers acute flares of gout?

Does gout increase the risk of developing renal stones?

What metabolic disorders are common comorbidities of gout?

What comorbid conditions complicate the use of medications to treat gout?

How is crystal-induced arthritis differentiated from cellulitis or septic arthritis in suspected gout?

Which joints should be examined in cases of gout or pseudogout?

Which physical findings of the joints indicate gout?

What are tophi and how are they associated with gout?

What is the typical presentation of tophi in gout?

Does gout affect the eye?

What are complications of gout?

DDX

What are the diagnostic criteria for gout?

Which disorders should be considered in the differential diagnoses of gout and pseudogout?

What are the differential diagnoses for Gout and Pseudogout?

Workup

What is the role of arthrocentesis in the evaluation of suspected gout?

How do the crystals of gout and pseudogout appear on microscopic analysis?

What is the importance of WBC count in synovial fluid during the evaluation of suspected gout or pseudogout?

Does an elevated serum uric acid level confirm a diagnosis of acute gout?

What should be included in the evaluation of pseudogout in an initial attack of arthritis with calcium pyrophosphate (CPP) crystals?

How does an acute attack of gout affect the WBC count and the erythrocyte sedimentation rate?

Which imaging studies are indicated in the evaluation of suspected gout or pseudogout?

Is synovial fluid analysis useful in the diagnosis of gout and pseudogout?

Which synovial fluid analysis findings confirm a diagnosis of gout or pseudogout?

What is the sensitivity and specificity of synovial fluid analysis in the diagnosis of gout?

What WBC count in synovial fluid indicates gout?

What do synovial fluid glucose levels indicate in regard to gout?

Can crystalline arthritis and infectious arthritis coexist in patients with gout?

How are pathologic specimens of synovial fluids processed in the workup of gout?

Are repeat joint aspirations needed once a diagnosis of gout is established by confirmation of crystals?

Should serum uric acid testing be used in the diagnosis of gout?

Should asymptomatic hyperuricemia be treated in patients with gout?

Does the level of serum uric acid correlate with risk of developing gout?

How is urinary uric acid evaluation used in the diagnosis of gout and pseudogout?

Are blood studies useful in the diagnosis of gout and pseudogout?

Is radiography useful in the diagnosis of gout and pseudogout?

What are characteristics of erosions typically found in gout?

What ultrasonographic findings indicate gout?

What is the sensitivity of the double contour sign for crystalline arthritis, gout, and calcium pyrophosphate deposition disease?

Is ultrasonography or radiography more sensitive in the detection of calcium pyrophosphate crystal deposition (CPPD)?

Can ultrasonography identify urate crystal deposition in asymptomatic gout?

Can ultrasonography detect tendon involvement in gout?

How is CT scanning used in the diagnosis of gout?

How is MRI used in the diagnosis of gout?

What are the histological findings of gout?

What are the histological findings of pseudogout?

Treatment

How is gout managed?

Do guidelines exist for the management of gout?

How is asymptomatic hyperuricemia treated?

Does urate-lowering therapy decrease the risk of kidney damage in gout?

Does urate-lowering therapy increase the risk of gout flares?

What are common risk factors for gout flares?

Is prophylaxis against gout flares required during the first year of urate-lowering therapies?

What are the indications for surgical removal of tophi with gout?

What are the treat-to-target recommendations for gout?

How does the treatment of pseudogout differ from the treatment of gout?

Should gout or pseudogout be treated without a proven diagnosis?

What are options for the treatment of acute gout?

How is hyperuricemia managed in gout?

When should NSAIDS be used in the treatment of gout?

What is the appropriate dosage of NSAIDS for controlling acute attacks of gout?

Is colchicine effective in the treatment of acute gout?

What are the dosage and regimen recommendations for colchicine in the treatment of acute gout?

When should colchicine be avoided as treatment for acute gout?

Is a clinical response to colchicine pathognomonic for gout?

Is IV colchicine available in the US?

When should corticosteroids be considered in the treatment of acute gout?

Which corticosteroid regimens are recommended for acute gout?

Which combination therapies may be considered for acute gout?

How is lesinurad (Zurampic) used in the treatment of chronic gout?

How should the first attack of gout be treated?

What is the risk of a recurrent attack of gout?

What are the ACR guidelines for urate-lowering therapy in gout?

What is the goal of the long-term management of gout?

Are there guidelines that do not recommend the "treat-to-target" approach to controlling serum uric acid levels in gout?

Which medications should be avoided in gout?

How is underexcretion of uric acid treated in gout?

What are the ACR treatment guidelines for gout in patients with renal disease?

What are the prophylactic treatments for gout?

What are the recommended dosages of colchicine for prophylaxis of gout?

What are the possible adverse effects of colchicine for prophylaxis of gout?

Should uric acid–lowering therapy be discontinued if a gout flare develops?

What is the role of allopurinol in the treatment of chronic gout?

What are the possible adverse effects of allopurinol?

Which patients with gout are at increased risk of developing severe allopurinol hypersensitivity syndrome?

What is the recommended dosage of allopurinol in the treatment of chronic gout?

Which drug interactions should be considered prior to prescribing allopurinol in patients with gout?

What is the likelihood of treatment compliance in patients with gout who are prescribed allopurinol and how can it be improved?

How is febuxostat used in the treatment of chronic gout?

What is the efficacy and safety of febuxostat in lowering hyperuricemia?

What is the efficacy and safety of febuxostat in lowering hyperuricemia in patients aged 65 years or older?

What is the efficacy and safety of febuxostat in lowering hyperuricemia in black patients?

What is the efficacy and safety of febuxostat in lowering hyperuricemia in women?

What is the efficacy of lesinurad in the treatment of gout?

How is nonrecombinant urate-oxidase (uricase) used in the treatment of chronic gout?

What are the potential adverse effects of pegloticase?

Is benzbromarone safe to use in the treatment of gout?

Is vitamin C effective in the treatment of gout?

Is the interleukin (IL)-1 antagonist anakinra effective in the treatment of gout?

Is fenofibrate an effective treatment for gout?

Is canakinumab FDA approved for the treatment of gout?

What foods high in purines should be avoided by patients with gout?

Are diet modifications successful in reducing uric acid levels in gout?

Should patients with gout drink alcohol?

Should sugar and salt be restricted in gout?

How does hydration affect gout?

Is weight reduction helpful for gout?

Should physical activity be restricted in gout?

When should consultations be considered for gout?

What monitoring should be performed in gout?

Can diet affect the risk for development of gout?

Guidelines

What are the evidence grades used in ACR guidelines for gout?

What are the ACR treatment guidelines for gout?

What are the ACR guidelines for general health, diet, and lifestyle measures in patients with gout?

What comorbidities do the ACR guidelines recommend as considerations in the clinical evaluation of gout?

What are the ACR guidelines for medication therapy in gouty arthritis?

What are the ACR guidelines for treatment to target serum uric acid levels in gout?

What are the ACR guidelines for the use of allopurinol ULT in gout?

What are the ACR guidelines for the use of uricosuric urate-lowering therapy (ULT) in gout?

What are the ACR treatment guidelines for refractory gout?

What are the ACR guidelines for long-term management of gout?

When should referral to a specialist be considered in gout?

What are the ACR guidelines for prophylaxis of acute gout?

What are the ACR guidelines for treatment of acute gout arthritis?

What are the ACP guidelines for the diagnosis of acute gout?

What are the ACP guidelines for the treatment of acute and recurrent gout?

Medications

Which medications are used in the treatment of gout and pseudogout?

Which medications in the drug class Nonsteroidal Anti-inflammatory Drugs (NSAIDs) are used in the treatment of Gout and Pseudogout?

Which medications in the drug class Uricosuric Agents are used in the treatment of Gout and Pseudogout?

Which medications in the drug class Corticosteroids are used in the treatment of Gout and Pseudogout?

Which medications in the drug class Xanthine Oxidase Inhibitors are used in the treatment of Gout and Pseudogout?

Which medications in the drug class Selective Uric acid Reabsorption Inhibitor (SURI) are used in the treatment of Gout and Pseudogout?

Which medications in the drug class Rheumatologics, Other are used in the treatment of Gout and Pseudogout?

Which medications in the drug class Corticotropic Hormones are used in the treatment of Gout and Pseudogout?

Which medications in the drug class Combination drugs are used in the treatment of Gout and Pseudogout?