Gout and pseudogout

EBM Guidelines
Sep 3, 2018 • Latest change Feb 27, 2019
Heikki Julkunen

Table of contents


  • Gout and pseudogout (chondrocalcinosis, pyrophosphate arthropathy) are common disorders causing arthritis in one or few joints.
  • A synovial fluid sample should be taken whenever gout (sodium urate crystals) or pseudogout (pyrophosphate crystals) is suspected.
  • Acute arthritis in a patient with arthrosis of large joints may be due to pseudogout requiring topical treatment with a glucocorticoid and anti-inflammatory analgesics.
  • Brief oral courses of glucocorticoids are increasingly used for the treatment of acute gout, and treatment can be intensified by topical intra-articular injections.
  • After the very first gout attack, provision of dietary instructions, survey of any cardiovascular disease or risk factors for such disease, as well as their treatment, as necessary, are indicated.
  • The treatment of intermittent or chronic gout aims to remove monosodium urate deposits from the body to make the patient completely asymptomatic.
  • Plasma urate levels should be lowered to below 360 µmol/l or, in a severe disease, to below 300 µmol/l to speed up the dissolving of accumulated gouty masses.
  • The treatment of intermittent and chronic gout is insufficient. Providing patients with comprehensive information on the clinical picture of gout, the importance of lifestyle changes and the aims of medication, as well as regular follow-up, improve the results of treatment.

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Allopurinol, Azathioprine, Creatinine, Gout, Hyperuricemia, Indomethacin, Internal medicine, Kidney Calculi, Kidney Failure, M10*, M11*, Methylprednisolone, Monosodium urate, Probenecid, Renal Insufficiency, Rheumatology, Sodium Bicarbonate, Synovial Fluid, Urate, Uric Acid, gout, secondary, monoarthritis