Gout -contd

Differential diagnosis


An important differential diagnosis in gout is septic arthritis.[3] This should be considered in those with signs of infection or those who do not improve with treatment.[3] To help with diagnosis a synovial fluid gram stain and culture may be performed.[3] Other conditions which present similarly include pseudogout and rheumatoid arthritis.[3] Gouty tophi, in particular when not located in a joint, can be mistaken for basal cell carcinoma,[24] or other neoplasms.[25]



[edit] Prevention

Both lifestyle changes and medication can decrease uric acid levels. Dietary and lifestyle choices that are effective include reducing intake of food high in purines such as meat and seafood, consuming adequate vitamin C, limiting alcohol and fructose consumption and avoiding obesity.[2] A low-calorie diet in obese men decreased uric acid levels by 100 µmol/L (1.7 mg/dL).[14] Vitamin C intake of 1,500 mg per day decreases the risk of gout by 45% compared to 250 mg per day.[26] Coffee but not tea consumption is associated with a lower risk of gout.[27] Gout may be secondary to sleep apnea via the release of purines from oxygen-starved cells. Treatment of apnea can lessen the occurrence of attacks.[28]



[edit] Treatment

The initial aim of treatment is to settle the symptoms of an acute attack.[29] Repeated attacks can be prevented by different drugs used to reduce the serum uric acid levels.[29] Ice applied for 20 to 30 minutes several times a day decreases pain.[2][30] Options for acute treatment include nonsteroidal anti-inflammatory drugs (NSAIDs), colchicine and steroids[2] while options for prevention include allopurinol, probenecid and febuxostat. Lowering uric acid levels can cure the disease.[31]

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