03-06-2025
5 Things You Need to Know When Treating Gout
Welcome to Rheum With a Viewpoint . My name is Dr Arinola Dada, and I've been practicing rheumatology for 20 years. Let's talk about five things you need to know when you're treating patients with gout.
1. Your patients have been taking anti-inflammatory medications when you were not looking.
It's possible that your patients may have some kidney damage, so when they call you on Saturday night to report an acute attack of gout and your first instinct is to order indomethacin, take a pause and consider trying something else. My go-to medication is prednisone.
2. How much prednisone should you give your patient?
The secret in the world of rheumatology is to go slow. You can start with 40 mg/d of prednisone for 4 days, then taper down to 30 mg/d for 4 days, then 20 mg/d for 4 days, and continue to reduce in that fashion. That secret sauce is going to help you treat your patient's acute gout.
3. When should you start allopurinol?
You should not start allopurinol during an acute attack. Remember, allopurinol does not treat acute attacks. Allopurinol is there to help lower uric acid levels in the blood. It's useful for prevention and management, but you want to start allopurinol after an acute attack of gout has settled. If the patient is already on allopurinol, they can continue taking their medication without adjusting the dose. Simply treat the acute attack.
4. Women tend to get tophi in their fingers.
You may want to look closely if you have a female patient with suspected gout. Patients report that this acute pain feels like somebody smashed their finger with a hammer. That kind of complaint would give you insight that your female patient may actually be experiencing gout in her DIP joints or inside her Heberden nodes.
5. Remember that when patients have tophi, they may not be able to feel it.
Talk to your local radiologist to see if you can order a dual-energy CT (DECT) scan. It really helps differentiate between gout and pseudogout.
