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→Gout
=Gout=
=Gout=
*H&P: Monoarthritis, swollen, red, very painful joint, most commonly the first carpometatarsal joint; can be associated with tophi if chronic; risk factors include obesity, male, Pacific Islanders, cancer, renal disease, Thiazide diuretic use, and high meat/alcohol consumption.
*H&P: Monoarthritis, swollen, red, very painful joint, most commonly the first carpometatarsal joint; can be associated with tophi if chronic; risk factors include obesity, male, Pacific Islanders, cancer, renal disease, Thiazide diuretic use, and high meat/alcohol consumption.
*Dx: Joint aspirate reveals negatively birefringent needle shaped monosodium urate crystals that are yellow with parallel light, with WBCs < 2000. Differential diagnosis of monoarthritis includes pseudogout (rhomboid shaped, positively birefringent, calcium pyrophosphate crystals), [[septic arthritis]], trauma, [[reactive arthritis]], '''[[Hemochromatosis]]''', and [[Lyme disease]].
*Dx: Joint aspirate reveals negatively birefringent needle shaped monosodium urate crystals that are yellow with parallel light, with WBCs 3-50k. Differential diagnosis of monoarthritis includes pseudogout (rhomboid shaped, positively birefringent, calcium pyrophosphate crystals), [[septic arthritis]], trauma, [[reactive arthritis]], '''[[Hemochromatosis]]''', and [[Lyme disease]].
*Tx: First-line is high-dose NSAIDs (e.g. Indomethacin, '''but avoid in ESRD''') or colchicine, second-line is '''intra-articular corticocorticoids'''. Give allopurinol once the acute symptoms resolve to prevent recurrences.
*Tx: First-line is high-dose NSAIDs (e.g. Indomethacin, '''but avoid in ESRD''') or colchicine, second-line is '''intra-articular corticocorticoids'''. Give allopurinol once the acute symptoms resolve to prevent recurrences.