Difficulties and Mistakes in the Management of the Patient with Gout
Journal Title: Біль. Суглоби. Хребет - Year 2016, Vol 4, Issue 24
Abstract
The issues of the most frequent mistakes and difficulties in the early gout diagnosis and further patient management are discussed in the article. It is known that the diagnosis of gout is made in the first year of the disease only in 1/4 cases, on the average 7–8 years pass until the disease is revealed. Only in one out of 4–5 cases gout is correctly verified in early stages. The reasons of the late diagnostics are the features of the course of gout with periods of absence of a symptom (intermittent gout), diagnostic errors at the first patient encounter, early conduction of X-ray examination without revealing the typical signs of the disease, the lack of joint puncture and verification of uric acid crystals in the synovial fluid. Another cause of diagnostic errors is the determination of the level of uric acid in the blood serum during acute attack. Late diagnosis of gout leads to a series of further diagnostic and tactical mistakes. First of all, this includes the prescription of non-steroidal anti-inflammatory drugs and glucocorticoids without the correct diagnosis. Current recommendations for the management of patients with gout emphasize that the use of glucocorticoids to treat gout is possible only for short courses, their long-term use is not allowed due to the high risk of side effects in this group of patients, who often have comorbidities. Another tactical error is the prescription of urate-lowering drugs in the period of acute arthritis without dose titration and without prescription of anti-inflammatory therapy. The paper presents a clinical case of the late diagnosis of gout involving inefficient treatment with the long-term use of glucocorticoids and absence of administration of urate-lowering drugs resulting in serious side effects — development of diabetes mellitus and hypertension. A detailed analysis of the clinical errors is conducted; recommendations on the rational tactics in this case are presented.
Authors and Affiliations
S. A. Trypilka, I. Yu. Golovach
Keywords
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