Gout and its differential diagnosis

Arthritis urica is one of the most frequent forms of arthritis in Switzerland. On one hand it can mimic septic arthritis, on the other hand it may progress into chronic polyarticular disease. Age, sex and initial clinical presentation lead to the suspicion of crystal arthropathy. The diagnosis, however, has to be proven by microscopic analysis of synovial fluid. Functional ultrasound may be extremely helpful in collecting minute amounts of liquid in small joints. This approach enables definite diagnosis and at the same time crystalline glucocorticoids together with local anesthetics can be injected intra-articularly in order to interrupt the inflammatory process and to kill pain. Other conventional treatment modalities include non-steroidal anti-inflammatory drugs (including Cox-2 inhibitors) which should be started immediately and at maximal doses as well as glucocorticoids at moderate doses for a few days. Serum uric acid levels should be normalized in order to prevent recurrence of arthritis.