Clinical QuickieMusculoskeletal
Gout
Treat the flare, then treat the urate.
Uric acid can be normal during a flare
A single serum urate value does not rule gout in or out during acute inflammation.
Septic arthritis stays in the differential
A hot swollen joint with fever, immunocompromise, prosthetic joint, or atypical features may need aspiration.
Flare treatment is anti-inflammatory
NSAID, colchicine, or corticosteroid strategies depend on kidney function, GI/CV risk, diabetes, interactions, and timing.
Long-term urate control is a different job
Recurrent flares, tophi, nephrolithiasis, and selected high-risk patients may need urate-lowering therapy with a treat-to-target strategy.
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