From the Guidelines
Assessing gout arthritis should start with a detailed clinical evaluation, including history and physical examination, followed by laboratory tests and imaging studies, with the gold standard for diagnosis being joint aspiration with synovial fluid analysis for monosodium urate crystals, as recommended by the American College of Physicians 1 and the European League Against Rheumatism 1. The clinical evaluation should focus on sudden-onset joint pain, especially in the first metatarsophalangeal joint, ankles, or knees, along with redness, swelling, and warmth.
- Key points to consider in the history include:
- Previous similar acute arthritis episodes
- Rapid onset of severe pain and swelling
- Erythema
- Male gender and associated cardiovascular diseases and hyperuricaemia
- The physical examination should document affected joints, degree of inflammation, and presence of tophi (urate crystal deposits). Laboratory tests are essential, with serum uric acid levels typically elevated above 6.8 mg/dL, though normal levels don't exclude gout during acute attacks, as noted in the 2020 American College of Rheumatology guideline for the management of gout 1.
- Supporting tests include:
- Complete blood count
- Inflammatory markers (ESR, CRP)
- Kidney function tests Imaging can help, with X-rays showing normal findings in early disease but erosions with overhanging edges in chronic gout, while ultrasound may reveal the "double contour" sign and dual-energy CT can identify urate deposits, as recommended by the European League Against Rheumatism 1. For comprehensive assessment, evaluate for comorbidities like hypertension, diabetes, and kidney disease, as these influence treatment decisions and long-term management of this metabolic arthritis, as emphasized in the 2020 American College of Rheumatology guideline for the management of gout 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Assessment of Gout Arthritis
To assess gout arthritis, the following methods can be used:
- Synovial fluid aspiration and analysis is the gold standard for making the diagnosis of gout 2
- A presumptive (or clinical) diagnosis of gout may be made in consultation with published recommendations and criteria from expert societies, based on a thorough patient history and physical examination, as well as serum urate measurement at the time of an acute attack and at follow-up 2 weeks later 2
- Lifestyle modifications form a part of gout prevention 3
Diagnostic Criteria
The diagnostic criteria for gout include:
- Presence of monosodium urate crystals within synovium of joints 4
- Severe pain and reducing quality of life for patients with this condition 4
- Painful flares and tophaceous deposits are debilitating, reduce quality of life and put strain on health-care systems 3
Treatment Options
The treatment options for gout include:
- Standard pharmacotherapies for gout flares include colchicine, NSAIDs, and oral or intramuscular corticosteroids, with IL-1 inhibitors newly established as an option for flare refractory to standard therapies 4
- Urate-lowering therapies aim to prevent gout flares, with an emphasis on treat-to-target strategy; the escalation of therapies until the target serum uric acid is reached 4
- Initial treatments include allopurinol and febuxostat, with uricosuric agents, probenecid, sulfinpyrazone, and benzbromarone, as adjuncts 4
- Low-dose colchicine can adequately prevent gout flare with fewer adverse events compared with regular-dose colchicine 5
Efficacy and Safety of Treatments
The efficacy and safety of treatments for acute gout have been evaluated in several studies:
- Moderate quality evidence concluded that systemic glucocorticoids were as effective as NSAIDs but safer 6
- Low quality evidence showed that both high- and low-dose colchicine were more effective than placebo, and low-dose colchicine was no different to placebo with respect to safety but safer than high-dose colchicine 6
- Moderate quality evidence found that 150 mg canakinumab was more effective than a single dose of intramuscular glucocorticoid and equally safe 6