© Springer International Publishing Switzerland 2015
Molly Blackley Jackson, Somnath Mookherjee and Nason P. Hamlin (eds.)The Perioperative Medicine Consult Handbook10.1007/978-3-319-09366-6_3737. Gout and Pseudogout
(1)
Division of General Internal Medicine, Department of Medicine, University of Washington, Seattle, WA, USA
Background
Surgery is a risk factor for development of crystal arthropathy or for a flare of preexisting crystal arthropathy [1]. Gout or pseudogout should be considered in patients with joint pain, unexplained fever, leukocytosis, or difficulty with physical therapy. It is vital not to ignore the patient’s joint exam, especially in patients who are slow to mobilize or who cannot give a history. Both gout and pseudogout are in the differential diagnosis of postoperative fever. Correctly diagnosing postoperative gout or pseudogout may lead to earlier treatment of the patient and help prevent barriers to postoperative recovery.
Preoperative Evaluation
Assess for a history of gout, including frequency of flares, medication regimen (including frequency of steroid use), whether there were any previous postoperative gout attacks, and uric acid levels (if appropriate). Examine the patient for any signs of joint redness or swelling suggestive of an acute flare. If such signs are present, consider initiating workup and treat flare (if it is in fact a crystal arthropathy) prior to surgery.
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