From the Guidelines
I strongly recommend continuing diclofenac for this 43-year-old male patient with bilateral foot pain and concerns about gout, as it has provided good relief and is a first-line treatment for acute gout flares 1. The patient's reported symptom relief with diclofenac supports its continued use for symptom management. Ordering a uric acid level is a good next step to evaluate for gout, as it will help determine if hyperuricemia is present, which would support a gout diagnosis 1. The patient is already in the queue for his Rosendahl appointment, which should be maintained for further evaluation. Diclofenac, a non-steroidal anti-inflammatory drug (NSAID), works by reducing inflammation and pain by inhibiting prostaglandin synthesis. For suspected gout, NSAIDs like diclofenac are first-line treatments for acute flares, and the uric acid level will help guide further management, including potential urate-lowering therapy for long-term management 1. Some key points to consider in gout management include:
- Patient education and lifestyle advice, such as weight loss, diet, and reduced alcohol consumption 1
- Addressing associated comorbidities, such as hyperlipidemia, hypertension, and hyperglycemia 1
- Using urate-lowering therapy, such as allopurinol, in patients with recurrent acute attacks, arthropathy, tophi, or radiographic changes of gout 1
- Monitoring serum uric acid levels to guide treatment and prevent crystal formation 1. Overall, continuing diclofenac and ordering a uric acid level are reasonable next steps in managing this patient's symptoms and evaluating for gout, with further management guided by the results of the uric acid level and other clinical factors 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Patient Presentation and Treatment
- The patient is a 43-year-old male presenting with bilateral foot pain and is concerned about having gout.
- The patient has been taking diclofenac, which has been effective in managing his symptoms.
- A uric acid level lab has been ordered, and diclofenac tabs will be prescribed for the patient.
Gout Diagnosis and Treatment
- Gout is characterized by swelling, pain, or tenderness in a peripheral joint or bursa, and can be diagnosed using validated clinical prediction rules 2.
- Arthrocentesis should be performed when suspicion for an underlying septic joint is present, and synovial fluid or tophus analysis should be performed if the diagnosis is uncertain 2.
- Colchicine, nonsteroidal anti-inflammatory drugs (NSAIDs), and corticosteroids can relieve pain in adults with acute gout episodes 2, 3.
Diclofenac Use and Safety
- Diclofenac is a commonly prescribed NSAID for managing pain, including acute pain in the emergency setting 4.
- Low doses of diclofenac have been shown to be safe and effective for short-term use, with a low risk of cardiovascular events when used for less than 30 days 4.
- New low-dosage diclofenac formulations may reduce the risk of cardiovascular events and are suitable for managing pain in the emergency setting 4.