Probenecid (Benemid) is a uricosuric agent that inhibits the reabsorption of uric acid in proximal tubules of the kidney.36 Pharmacologic therapy typically begins at 500 mg b.i.d. and gradually increased to a maximum dose of 3 g/day.37 Probenecid should not be used by patients prone to cholelithiasis or patients in an acute gouty attack. Efficacy decreases as renal function declines.37

In addition to urate-lowering therapies, oral colchicine 0.6 mg/day is useful.1 Colchicine therapy tends to be more advantageous in older individuals with mild renal failure and a history of multiple attacks.2 Also, daily NSAID therapy may help, but side effects typically occur with prolonged use.1


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Lifestyle modification

The most effective long-term treatment is lifestyle modification and prevention of such comorbidities as hypertension, hyperlipidemia, and diabetes. Patients should focus on weight reduction, additional physical activity, adequate hydration, avoidance of hyperuricemic medications, and reduced consumption of high-purine foods and drinks.1,2 Dietary modifications include decreasing intake of red meats, seafood, and alcohol, which have been found to increase uric acid levels in the blood. Increasing consumption of low-fat dairy products, fruits, vegetables, nuts, and legumes is advisable. Weight reduction through improved diet and increased exercise helps reduce uric acid levels and lowers the risk of comorbidities.38,39 Vitamin C supplementation has been shown to decrease flares through competition with uric acid reabsorption in renal tubules.39,40 Lifestyle modification has been shown to reduce flares and improve the outlook for the patient’s future. The side-effect profile of urate-lowering medications could be avoided if optimal lifestyle modification improves sUA levels to target goal.

Summary

Gouty arthritis is a common disorder that presents with classic findings of a warm, swollen, tender, and red joint (most commonly the first MTP joint). Although diagnosis is often made clinically, aspiration of the joint should be performed if suspicion is low to moderate. In these circumstances, it is important to consider other disease processes in the differential, as they often present similarly. Treatment differs depending on the disease, and in certain instances, treatment for gout may worsen conditions associated with other diagnoses (i.e., corticosteroids and septic arthritis). Additional lab studies can be ordered to aid in making the correct diagnosis. Other subtle differences in a patient’s history may assist in differentiation. Such measures as the ACR, New York, and Rome criteria help make the diagnosis of gouty arthritis. Early diagnosis and management through pharmacologic therapy and lifestyle modification can be beneficial in preventing chronic gouty arthritis.

Mr. Crosby is a second-year student in the physician assistant program at Georgia Health Sciences University in Augusta, where Ms. Haddow is an assistant professor and the director of education. The authors have no relationships to disclose relating to the content of this article.


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