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Consider referral to secondary care if:
Gout classically presents in first MTP. In any presentation of a hot joint (especially first presentation), septic arthritis should always be considered.
Gout is usually a clinical diagnosis.
Important differential diagnoses include:
Please refer suspected septic joints to the on-call orthopaedic team for joint aspiration.
Although the diagnosis of acute gout is usually made clinically, all patients with a suspected first attack should be investigated to:
1.Underlying causes:
2. Associated co-morbidities:
Associated co-morbidities include:
Check:
3. Evidence to support the diagnosis:
Consider the following investigations for the diagnosis of chronic or recurrent gout:
For detailed advice on the management, please follow the link
NICE guidance advises a target serum uric acid (SUA) of 360micromol/L to be satisfactory if symptoms are controlled.
The target should be lower than 300 micromol/L for patients with:
SUA should be checked monthly and treatment up-titrated to target
Once stable, check a SUA level annually (increases with age)
Acute attacks of gout can still occur for up to 2 years or longer and should be managed in the usual way - the frequency and intensity of attacks should gradually diminish and cease altogether.
Consider annual monitoring for co-morbidities (e.g. renal function, HbA1c, Lipids, BP)
Consider referral to secondary care if:
Refer to Rheumatology via the e-Referral Service:
Specialty: Rheumatology
Clinic Type: Rheumatology
Service: DRSS-South Devon & Torbay-Rheumatology- Devon ICB -15N
Evidence
This guideline has been signed off on behalf of NHS Devon.
Publication date: January 2023