Reference — Musculoskeletal
Gout Reference
Gout is crystal arthritis: urate crystals precipitate in a joint and the immune system attacks them. The classic story — sudden, exquisite pain in the great toe at night — is so distinctive that exams and triage nurses both lean on it. Management splits cleanly into stopping the flare and preventing the next one.
Educational use only. Medication choice and dosing — especially colchicine and urate-lowering titration — are provider-directed and renally adjusted. This material supports nursing education and exam review. It is not medical advice and is not a substitute for clinical judgment, institutional policy, or medical direction. Always follow facility protocols and current provider orders.
Recognition
An acute flare is abrupt — often overnight — monoarticular, and dramatic: the joint is red, hot, swollen, and so tender that the weight of a bedsheet hurts. The first metatarsophalangeal joint (podagra) is classic; ankles, knees, and wrists also flare. Fever can accompany a large flare, which is why septic arthritis is the must-not-miss mimic — a hot joint plus fever may need aspiration before anyone calls it gout.
Chronic untreated gout deposits urate as tophi — firm nodules on ears, fingers, and elbows — and drives urate kidney stones and progressive joint damage. Triggers for flares: alcohol (especially beer), purine-rich meals, dehydration, diuretics, aspirin, surgery, and illness.
Acute Flare vs Chronic Management
| Phase | Medications | Nursing Notes |
|---|---|---|
| Acute flare | NSAIDs (e.g., naproxen, indomethacin), colchicine, or corticosteroids | Colchicine: GI toxicity (diarrhea, nausea) signals stop/report; renal dosing matters. NSAIDs: GI bleed and renal cautions. Rest, elevate, cold per comfort — no weight on the joint. |
| Chronic (urate-lowering) | Allopurinol or febuxostat (xanthine oxidase inhibitors); probenecid (uricosuric) | Established therapy is not stopped during a flare. The 2020 ACR guideline now conditionally supports starting urate-lowering therapy during a flare too, as long as anti-inflammatory prophylaxis is given concurrently — initiation no longer has to wait for the flare to resolve. Allopurinol: report any rash immediately (severe hypersensitivity risk); push fluids. Probenecid: avoid aspirin, push fluids to prevent stones. |
Diet & Lifestyle Teaching
Limit high-purine foods
Organ meats (liver, kidney, sweetbreads), red meat, shellfish and oily fish (sardines, anchovies, herring), gravies and meat extracts. Beer and spirits raise urate; high-fructose drinks do too.
Encourage
Fluids — 2–3 L daily unless restricted — to flush urate; low-fat dairy, vegetables, and whole grains; gradual weight loss (crash dieting triggers flares); limiting alcohol.
Adherence framing
Urate-lowering therapy is daily and lifelong, and the first months may include flares while crystals dissolve — warn patients, because an expected flare misread as “the medicine isn’t working” is how adherence dies.
NCLEX Pearls
- ✦Allopurinol is prevention, not flare treatment, and established therapy continues through an attack. Note the 2020 ACR shift: urate-lowering therapy may now be initiated during a flare with concurrent anti-inflammatory prophylaxis, rather than waiting for resolution.
- ✦Colchicine + new diarrhea/vomiting = toxicity signal; hold and report per orders.
- ✦Rash on allopurinol is never minor — report immediately (Stevens-Johnson risk).
- ✦Organ meats, shellfish, sardines, beer — the purine list exams love.
- ✦Hot swollen joint + fever: think septic arthritis before gout — aspiration decides.
Related Resources
Standards & sources
Fact-checked Jun 21, 2026This page is written to align with American Academy of Orthopaedic Surgeons (AAOS) · National Association of Orthopaedic Nurses (NAON). It is an educational summary, not a citation of any single document — always verify specific doses, values, and protocols against current guidelines and your facility policy. How we source content →