From the Guidelines
To evaluate gout in the shoulder, start with a thorough clinical assessment and consider joint aspiration as the gold standard diagnostic procedure, as recommended by the 2018 updated European League Against Rheumatism evidence-based recommendations 1.
Clinical Assessment
Begin with a detailed history of sudden-onset severe shoulder pain, limited range of motion, redness, warmth, and swelling. Inquire about previous gout attacks, dietary habits, alcohol consumption, and medications that might affect uric acid levels. Physical examination should focus on signs of inflammation and tenderness.
Laboratory Tests and Imaging
Laboratory tests are essential, including serum uric acid levels (though these may be normal during an acute attack), complete blood count, inflammatory markers (ESR, CRP), and kidney function tests. Imaging studies like X-rays may show normal findings in early gout but can reveal erosions with chronic disease, while ultrasound might detect the "double contour" sign of crystal deposition, as noted in the 2017 systematic review in support of an American College of Physicians clinical practice guideline 1. MRI can help rule out other conditions.
Diagnostic Procedure
Joint aspiration is the gold standard diagnostic procedure, where synovial fluid is examined under polarized light microscopy for negatively birefringent monosodium urate crystals, as emphasized by the 2017 clinical practice guideline from the American College of Physicians 1.
Differential Diagnosis
Differential diagnosis should consider septic arthritis, rheumatoid arthritis, pseudogout, and rotator cuff injuries. Prompt diagnosis is important as gout in the shoulder is less common than in lower extremities, which can lead to misdiagnosis and delayed treatment.
Recommendations
The 2018 updated European League Against Rheumatism evidence-based recommendations suggest searching for crystals in synovial fluid or tophus aspirates in every person with suspected gout, and considering gout in the diagnosis of any acute arthritis in an adult, especially with suggestive features such as monoarticular involvement of a foot or ankle joint, previous similar acute arthritis episodes, and rapid onset of severe pain and swelling 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Evaluating Gout in the Shoulder
To evaluate gout in the shoulder, it is essential to understand the condition and its effects on the joint. Gout is a common form of acute inflammatory arthritis caused by the deposition of monosodium urate crystals within the synovium of joints, leading to severe pain and reduced quality of life for patients 2, 3.
Physical Examination
A physical examination of the shoulder is crucial in diagnosing shoulder pathology, including gout. The examination should include a standard assessment of the shoulder joint, followed by specific tests to further evaluate the shoulder and limit the differential diagnoses 4.
Key Considerations
When evaluating gout in the shoulder, consider the following:
- Gout can affect any joint, but it is more common in the feet, ankles, and knees. However, it can also occur in the shoulder joint.
- The diagnosis of gout is typically based on the presence of monosodium urate crystals in the synovial fluid of the affected joint.
- Treatment of gout in the shoulder may involve anti-inflammatory medications, such as NSAIDs, colchicine, or corticosteroids, as well as urate-lowering therapies to prevent future flares 2, 3, 5, 6.
- Management of gout in older adults requires careful selection of treatment based on potential benefits and consequences of therapy, considered in tandem with individual patient-specific characteristics 5.
Evaluation Steps
To evaluate gout in the shoulder, follow these steps:
- Take a thorough medical history to identify potential risk factors for gout, such as family history, diet, and comorbidities.
- Perform a physical examination of the shoulder joint to assess for signs of inflammation, such as redness, swelling, and warmth.
- Order laboratory tests, such as serum uric acid levels and synovial fluid analysis, to confirm the diagnosis of gout.
- Develop a treatment plan that takes into account the patient's individual needs and medical history, including the use of anti-inflammatory medications and urate-lowering therapies.