Hyperuricemia can result from both uric acid overproduction (metabolic/myeloproliferative diseases) in addition to uric acid underexcretion (more common).
Consider gout in any patient who complains of joint pain that reaches peak intensity over hours and may wake them from sleep. Septic joints tend to reach peak intensity of days.
Patients may have multi joint involvement, low-grade fever and leukocytosis (factors that may lead one to consider an alternative diagnosis)
Remember that gout is also a disease of the synovial tissue (tendonitis and bursitis).
NSAIDs: Traditional preferred treatment for acute gout
Colchicine: Less effective if the current attack is >24 hours. Use correct dosage for best effect/side effect ratio.
Steroids: At least as effective as NSAIDs.
References
Man CY, Cheung IT, Cameron PA, Rainer TH. Comparison of oral prednisolone/paracetamol and oral indomethacin/paracetamol combination therapy in the treatment of acute gout like arthritis: a double-blind, randomized, controlled trial. Ann Emerg Med. 2007;49:670-677.
