Summary
Definition
History and exam
Key diagnostic factors
- presencia de factores de riesgo
- hombres de >40 años
- uso de medicamentos que inducen a la gota
- consumo de carne, marisco o alcohol
- antecedentes de afección clínica con alta tasa de recambio celular
- dolor intenso de inicio rápido
- rigidez de las articulaciones
- distribución en las articulaciones del pie
- pocas articulaciones afectadas
- inflamación y derrame articular
- sensibilidad a la palpación
- tofos
Other diagnostic factors
- eritema y temperatura elevada
- antecedentes familiares de gota
Risk factors
- edad avanzada
- sexo masculino
- estado menopáusico
- consumo de carne, mariscos y alcohol
- uso de diuréticos
- uso de ciclosporina o tacrolimus
- uso de pirazinamida
- uso de aspirina
- susceptibilidad genética
- alta tasa de recambio celular
- obesidad
- adiposidad y resistencia a la insulina
- insulina exógena
- hipertensión
- insuficiencia renal
- diabetes mellitus
- hiperlipidemia
- antecedentes familiares de gota
Diagnostic investigations
1st investigations to order
- artrocentesis con análisis del líquido sinovial
Investigations to consider
- nivel de ácido úrico en el suero
- ultrasonido
- tomografía computarizada de energía dual (DECT)
- radiografía de las articulaciones afectadas
Treatment algorithm
gota aguda
gota recurrente: 2-3 semanas después del episodio agudo
Contributors
Authors
Fadi Badlissi, MD, MSc
Assistant Professor
Harvard Medical School
Attending Physician
Director of the Musculoskeletal Medicine Unit
Department of Orthopedics & Division of Rheumatology
Beth Israel Deaconess Medical Center
Boston
MA
Disclosures
FB has received an honorarium as an advisory board member for Horizon Pharmaceuticals.
Peer reviewers
H. Ralph Schumacher, Jr., MD
Professor of Medicine
VA Medical Center
Philadelphia
PA
Disclosures
HRS has been a consultant for a number of pharmaceutical companies that produce drugs that can be used for the treatment of gout. Some companies have supplied HRS with funding. HRS is an author of a number of references cited in this topic.
Ade Adebajo, MD
Associate Director of Teaching and Honorary Senior Lecturer in Rheumatology
Academic Rheumatology Group
Faculty of Medicine
University of Sheffield
Sheffield
UK
Disclosures
AA declares that he has no competing interests.
Martin Underwood, MBBS
Professor of Primary Care Research
Warwick Medical School
Coventry
UK
Disclosures
MU declares that he has no competing interests.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
References
Key articles
National Institute for Health and Care Excellence. Gout: diagnosis and management. Jun 2022 [internet publication].Full text
FitzGerald JD, Dalbeth N, Mikuls T, et al. 2020 American College of Rheumatology guideline for the management of gout. Arthritis Care Res (Hoboken). 2020 Jun;72(6):744-60. Abstract
Qaseem A, Harris RP, Forciea MA, et al; Clinical Guidelines Committee of the American College of Physicians. Management of acute and recurrent gout: a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2017 Jan 3;166(1):58-68.Full text Abstract
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
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