When to treat monoarticular arthritis for gout

This was a large prospective evaluation of patients with acute monoarticular arthritis, all of whom underwent diagnostic joint aspiration along with physical exam and lab evaluation. Based on a clinical scoring system, researchers found gout present in only 3% of patients with a low clinical score (<4) and 80% of those with a high score (>8). They recommend those with a high score be empirically treated, and those with scores between 4-8 undergo joint aspiration. [The clinical scoring system: Uric acid >5.8 mg/dL (3.5 points), 1st MT joint (2.5 points), Male (2 points), previous gout (2 points), HTN, >1 vascular syndrome, or CHF (1.5 points), Joint redness (1 point), 1 day onset (0.5 points)]. The scoring system can be very valuable for patients with acute monoarticular arthritis (abstract)

Danielle Scheurer

Dr. Scheurer is a clinical hospitalist and the Medical Director of Quality and Safety at the Medical University of South Carolina in Charleston, South Carolina, and is Assistant Professor of Medicine. She is a graduate of the University of Tennessee College of Medicine, completed her residency at Duke University, and completed her Masters in Clinical Research at the Medical University of South Carolina. She also serves as the Web Editor and Physician Advisor for the Society of Hospital Medicine.

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