Red Toe


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A 67-year-old man with diabetes mellitus, hypertension, and renal insufficiency arrives to the emergency department with three hours of right great toe pain and swelling.  When pressed, he reluctantly confirms a past diagnosis of gout, and his not taking his urate-lowering agent.  On exam, you see a man in moderate distress due to pain; he is mildy volume depleted. T 38.3 HR 96 BP 170/90 RR 20 98% RA.  His right first metatarsal joint is red, warm, and swollen.  On further exam, his left knee, right elbow, and right second metacarpophalangeal joint are mildly swollen and painful.   The rest of his history and physical examination are unremarkable.

Regarding the management of this patient, which of the following is TRUE:

    A.  Allopurinol, a xanthine oxidase inhibitor, is indicated to abort this gouty flare
    B.  High-dose colchicine is a safe, effective, and first-line treatment
    C.  The presence of podagra is a reliable indicator of a gouty flare 
    D.  NSAIDs such as aspirin are effective in treating gouty flares

In the meantime, a quote --   "The gout is so common a disease, that there is scarcely a man in the world, whether he has had it or not, but thinks he knows perfectly what it is." William Cadogan (1711-97), A Dissertation on the Gout, and All Chronic Diseases, Jointly Considered


BIG Mike
09/24/2012 1:12pm

Answer is D. Allopurinol is for prophylaxis treatment. High dose colchicine has many adverse side effects, usually nausea, vomiting and diarrhea but is associated with myelosuppression. There is debate about long term use of baby aspirin actually worsening gout but high stremgth aspirin is effective in acute flares.


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