Gout - what do you guys do?

[pinipig523]

How do you guys manage previously undiagnosed gout in the community? Say they have good follow up.

Classic story and classic patient (middle aged man, previous corroborating dietary story, etc), classic presentation - MTP of 1st toe.

Not toxic appearing. Has been going on for several days.

Do you tap or not?

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[Janders]

Toe? I don't usually.
Other joint? I do usually.

If the patient is reasonable, I generally explain to them what I am thinking... 99% sure its gout, only know for sure if we tap it, but if they want to avoid that we can try treating it and have them f/u with PCP in a few days for a recheck. I let them know the boogie-man is a septic joint. Most people agree with no tap, some decide they want a tap.

(oh, and I've tapped two toes [three times fast!] recently under u/s, which makes it a lot easier)

 

[Daiphon]

I agree with Janders; likely wouldn't tap podagra unless there was some other finding on exam that concerned me; I do offer it to the patient, however, and typically they decline.

Other joints, though, if the pt doesn't have an established diagnosis of gout, then I typically tap... if for no other reason than to firmly establish the diagnosis. It's relatively quick & easy, and the patients usually like it because it does reduce the pain somewhat (although not completely).

Cheers!
-d

 

[pinipig523]

Sounds great... that's what I did as well. No tap for podagra, follow up/return to ER.

Thanks fellas.