Summary
Definition
History and exam
Key diagnostic factors
- presença de fatores de risco
- homens com idade >40 anos
- uso de medicamento indutor de gota
- consumo de carne, frutos do mar ou bebidas alcoólicas
- história de doença com alta taxa de renovação celular
- dor intensa de início rápido
- rigidez da articulação
- distribuição da articulação do pé
- poucas articulações afetadas
- inchaço e derrame articular
- sensibilidade
- tofos
Other diagnostic factors
- eritema e calor
- história familiar de gota
Risk factors
- idade avançada
- sexo masculino
- estado de menopausa
- consumo de carne, frutos do mar, bebidas alcoólicas
- uso de diuréticos
- uso de ciclosporina ou tacrolimo
- uso de pirazinamida
- uso de aspirina
- susceptibilidade genética
- alta taxa de renovação celular
- obesidade
- adiposidade e resistência insulínica
- insulina exógena
- hipertensão
- insuficiência renal
- diabetes mellitus
- hiperlipidemia
- história familiar de gota
Diagnostic tests
1st tests to order
- artrocentese com análise do líquido sinovial
Tests to consider
- nível de ácido úrico sérico
- ultrassonografia
- tomografia computadorizada de dupla energia (DECT)
- raio-x da articulação afetada
Treatment algorithm
gota aguda
gota recorrente: 2-3 semanas após o episódio 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.
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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