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Obtain an MRI scan
8%
1/12
Obtain serum uric acid level
Await culture and sensitivity results to start antibiotics
17%
2/12
Inject a cortisone product, followed by management with oral nonsteroidal anti-inflammatory drugs (NSAIDs)
25%
3/12
Start colchicine 0.6 mg three times a day until resolution of symptoms
33%
4/12
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The aspiration specimen shows crystals that are weakly birefringent and rhomboid in shape, reflecting the strong likelihood of calcium pyrophosphate crystal disease. Given the severe pain, a cortisone injection following aspiration will be most useful. Gout is associated with uric acid crystals that are birefringent yet needle shaped. Serum uric acids are often normal in an acute gout attack. Colchicine is useful in treating gout. The treatment of acute pyrophosphate crystalline disorder includes NSAIDs or intra-articular glucocorticoids. The diagnosis of gout is usually confirmed by the presence of strongly birefringent needle-shaped monosodium urate crystals in aspirates of the involved joint. Because monosodium urate crystals often can be found in the first metatarsophalangeal joint and in knees not acutely involved with gout, arthrocentesis of these joints between attacks is a useful diagnostic tool. The serum level of uric acid has a limited role in the diagnosis of gout because it can be normal or low at the time of an acute attack. The mainstay of treatment during an acute gouty attack is the administration of colchicine or NSAIDs.
1.6
(20)
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