Risk stratifies for gout vs non-gout arthritis and helps determine which patients benefit most from joint aspiration.
The authors provide several recommendations based on a patient's score:
- ≤4 points: Unlikely gout. Other causes of monoarthritis should be considered, for example: pseudogout, septic arthritis, reactive arthritis, psoriatic, rheumatoid, or osteoarthritis.
- 4-8 points: These patients are most likely to benefit from joint aspiration and fluid analysis for urate crystals.
- ≥8 points: Gouty arthritis is very likely, and empiric gout medications can be started as opposed to more generic arthritis treatments (like NSAIDs).
- Gout flares are often treated with some combination of steroids, NSAIDS (classically, indomethacin), opioids for extreme pain, and colchicine, depending on a patient's age and other risk factors for complications.
- After the initial flare, patients may benefit from irate-lowering therapies like allopurinol.