Diagnosis and Treatment of Gout in the Intensive Care Unit

Abstract

Gout is a common cause of arthritis resulting from formation of monosodium urate crystals in synovial tissues. The incidence of this condition in the critically ill population is unknown, but gout can result in short-term morbidity and it can occasionally complicate management of a patient's primary condition. The diagnosis of gout should be considered in any patient in whom acute arthritis or bursitis develops. Aspiration of the involved joint or bursa and identification of crystals using either polarized or light microscopy are mandatory. Treatment options in critically ill patients differ from the usual treatment of gout because most critically ill patients have or are at risk for renal dysfunction and gastrointestinal bleeding, thus making use of nonsteroidal anti-inflammatory agents and colchicine hazardous. Intravenous colchicine in critically ill patients should be used with extreme caution, if at all, because the risk of bone marrow toxicity and other complications are well described in this patient population. Initial regimens should include use of adrenocorticotropic hormone, intra-articular corticosteroids, or systemic steroids. Analgesics may be beneficial as primary therapy in minor cases of acute gout, and they may be useful as adjunctive therapy in more severe cases. The role of colchicine as a prophylactic agent is discussed, as are treatment options in the allograft transplant population, in which rapidly progressive gout is increasingly common.