[Summary of the Dutch College of General Practitioners' "Gout" Standard].
The typical form of acute gout can be clinically diagnosed. The term 'complicated gout' is used if there are more than three acute attacks of gout per year, tophi or urate stones in the urinary tracts. In the case of recurrent probable acute gout, a diagnostic fine needle aspirate from the joint during an attack is indicated. First choice treatment of acute gout consists of NSAIDs. Colchicine is the second choice treatment and the third choice treatment consists of corticosteroids. Excessive alcohol use should be limited. Treatment of chronic gout depends on the uric acid excretion in the 24-hour urine. If the level of excretion is too low, the first choice should be benzbromarone, and if the uric acid output is too high, allopurinol should be the treatment of first choice. Increased fluid intake is recommended; maintenance treatment with colchicine is not advised. Consultation with or referral to a rheumatologist is indicated in the case of doubt about the diagnosis of 'acute gout' or 'complicated gout', or (suspected) bacterial arthritis and insufficient treatment effect.
Romeijnders
A C M
AC
Nederlands Huisartsen Genootschap, afd. Richtlijnontwikkeling en Wetenschap, Postbus 3231, 3502 GE Utrecht.
Gorter
K J
KJ
D000208:Acute Disease; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000493:Allopurinol / Q000627:therapeutic use; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D001553:Benzbromarone / Q000627:therapeutic use; D002908:Chronic Disease; D003078:Colchicine / Q000627:therapeutic use; D006073:Gout / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy*; D006074:Gout Suppressants / Q000627:therapeutic use*; D006801:Humans; D009426:Netherlands; D017410:Practice Guidelines as Topic / Q000592:standards*; D012008:Recurrence; D014528:Uricosuric Agents / Q000627:therapeutic use
D000305:Adrenal Cortex Hormones; D000894:Anti-Inflammatory Agents, Non-Steroidal; D006074:Gout Suppressants; D014528:Uricosuric Agents; D001553:Benzbromarone; D000493:Allopurinol; D003078:Colchicine