Management of Gouty Arthritis of the Foot and Ankle : ACFAS/AANP guidance
A joint clinical consensus statement issued by the American College of Foot and Ankle Surgeons and the American Association of Nurse Practitioners (ACFAS/AANP) reports that the use of non-steroidal anti-inflammatory drugs (NSAIDs) for the first-line treatment of gout is appropriate.
The consensus statement published in The Journal of Foot & Ankle Surgery which included 23 individual statements, was developed by a 7-member panel that included 3 podiatric foot and ankle surgeons and 4 nurse practitioners.
The panel reached a consensus that the following statements were “appropriate”:
- Patients on thiazide diuretics are at higher risk for gout flares.
- Patients with excessive alcohol consumption are at higher risk for gouty flares.
- Diet is a risk factor for gout.
- Diet modification has an effect on decreasing incidence of recurrence.
- Age is a risk factor for gout.
- Standard workup for an initial acute gout episode should include blood uric acid level, erythrocyte sedimentation rate, C-reactive protein, complete blood count, and serum creatinine.
- Advanced imaging is not necessary to diagnose gout.
- Joint aspiration and microscopy are the gold standards for making the diagnosis of gout.
- Nonsteroidal anti-inflammatory drugs should be used as the first-line treatment for acute gout.
- Allopurinol should be titrated until the serum urine uric acid level is <6.0 mg/dL.
- Long-term medications, such as allopurinol, are necessary for the treatment of recurrent gout.
- Multidisciplinary referral provides optimal care in cases of recalcitrant gout.
- Patient education should include dietary modification, medication adherence, and follow-up care with their assigned health care providers.
The panel reached a consensus that the following statement was “inappropriate”:
- Hyperuricemia is always indicative of gout.
The panel reached a consensus that the following statements were “neither appropriate nor inappropriate”:
- Chemotherapy places a patient at higher risk for gout.
- Patients with body mass index >27 are at higher risk for gout.
- Ethnicity, race, and socioeconomics play a great role in regard to the incidence of gout.
- The panel was unable to reach consensus on the following statements:
- Patients with diabetes mellitus are at higher risk for gouty flares.
- Women are not at higher risk for gout.
- Colchicine should be taken daily for 6 to 12 months post-acute gouty flares in patients with recurrent gouty attacks.
- Joint injections are preferred over oral steroids as initial treatment of acute gout.
- Joint implant replacement should be considered in cases of chronic gout.
- Arthroscopic debridement may be used in acute or chronic gout.
Gout is a condition that commonly affects the foot and ankle. Although the acutely red, hot, swollen joint is a common presentation, chronic tophaceous gout can be associated with pain, nodule formation, and cutaneous compromise.
For full information log on to https://doi.org/10.1053/j.jfas.2018.08.018