An acutely inflamed joint usually warrants aspiration. Examination of the synovial fluid is the best way to differentiate
bacterial infection from crystal-induced arthritis and other less common disorders. The treatment of
acute gout is determined by the patient’s comorbidities. Confirmation of the diagnosis of gout by identifying urate
crystals is of great value prior to commencing long-term urate-lowering drug therapy (ULT). When ULT is used,
achieving the target serum urate level is of vital importance. In the early phase there is an increased risk of
flares and the risk is higher if the serum urate falls more rapidly. It is wise to introduce ULT at a low dose and to
use prophylactic drug therapy to avoid flares.
Modern Medicine – September 2017