Management Plan Tod Gouseau
Primary Diagnosis- Gout
A form of inflammatory arthritis that is characterized by painful inflammation of the joints,
primarily the first MTP joint, but can also be seen in the fingers, wrists, knees, elbows and
ankles. The accumulation of monosodium urate crystals in the joint area causes the affected joint
to swell, become very sensitive, and warm, lasting for a few hours or days (FitzGerald et al.,
2020). A person's mobility and quality of life may be significantly impacted by these painful
episodes. An important risk factor is age, with middle-aged and older persons having a higher
incidence of gout. Other risk factors include heredity, sex, and diet. A diet heavy in purines, like
shellfish, organ meats, and sugar-filled beverages, raises the chance of developing gout. Gout
can be influenced by genetics, as those who have a family history of the disorder are more likely
to develop it. (FitzGerald et al., 2020). This patient has multiple risk factors for the development
of gout that include age, sex, diet high in sardines, and seafood, alcohol use, and diuretic use for
blood pressure management. The patient has a tophus on the left big toe, a similar episode one
year ago, and synovial fluid analysis was positive for needle-like crystals with negative
birefringence indicative of monosodium urate crystals and elevated uric acid, serum uric acid
was also. elevated. Gout is the most likely diagnosis.
Codes
• Gout – (acute) (attack) (flare) M10.9 (ICD-10 Code Lookup, 2019).
• CPT codes- (AAPC, 2023).
• CPT code- 99214 - Office visit, established patient.
• CPT code 36415 – routine venipuncture.
• CPT code 20610- arthrocentesis, aspiration and/or injection, major joint or bursa: without
ultrasound.
, • CPT code 89060- Crystal identification by light microscopy with or without polarizing
lens analysis, tissue, or any body fluid.
Guidelines- 2020 American College of Rheumatology Guideline for the Management of Gout
(FitzGerald et al., 2020) (American College of Rheumatology, 2023).
1. Treatment of acute gout episode- Pharmacological- Nonsteroidal anti-inflammatory drugs
(NSAIDs), corticosteroids, or colchicine, are recommended first-line treatments for gout
flare-ups (FitzGerald et al., 2020).
• NSAID- Naproxen 500mg po bid with food, x 7 days, #30, for pain and
inflammation, monitor for bleeding, ulcers. Reduce to Naproxen 250mg bid for
prophylaxis for 3-6 months.
• Corticosteroid -Prednisone 10mg tabs, 3 tabs (30mg) po qd with food x 5 days,
#15, for inflammation- monitor for mood changes, elevated BP.
• Colchicine – 0.6mg, 2 tabs (1.2mg) po x 1 followed by one tab (0.6mg) po after
one-hour, #3, – monitor for n/v/diarrhea, avoid grapefruit products. Reduce to
colchicine 0.5mg po qd for prophylaxis for 3-6 months.
• Management to prevent recurrent flare-ups
o Start allopurinol to prevent flare-ups 2-3 weeks after acute attack (American
College of Rheumatology, 2023). Allopurinol 100mg, one po qd, incr. 100
mg/day q2wks until uric acid <6 mg/dL, #45. Take with a full glass of water,
take with food if upset stomach. Monitor kidney and liver function, monitor
for painful rash,(Stevens-Johnson Syndrome), bloody urine, signs of infection,
and liver problems.
2. Non-Pharmacological (American College of Rheumatology, 2023).
• Low purine diet, decrease consumption of red meat, seafood
Primary Diagnosis- Gout
A form of inflammatory arthritis that is characterized by painful inflammation of the joints,
primarily the first MTP joint, but can also be seen in the fingers, wrists, knees, elbows and
ankles. The accumulation of monosodium urate crystals in the joint area causes the affected joint
to swell, become very sensitive, and warm, lasting for a few hours or days (FitzGerald et al.,
2020). A person's mobility and quality of life may be significantly impacted by these painful
episodes. An important risk factor is age, with middle-aged and older persons having a higher
incidence of gout. Other risk factors include heredity, sex, and diet. A diet heavy in purines, like
shellfish, organ meats, and sugar-filled beverages, raises the chance of developing gout. Gout
can be influenced by genetics, as those who have a family history of the disorder are more likely
to develop it. (FitzGerald et al., 2020). This patient has multiple risk factors for the development
of gout that include age, sex, diet high in sardines, and seafood, alcohol use, and diuretic use for
blood pressure management. The patient has a tophus on the left big toe, a similar episode one
year ago, and synovial fluid analysis was positive for needle-like crystals with negative
birefringence indicative of monosodium urate crystals and elevated uric acid, serum uric acid
was also. elevated. Gout is the most likely diagnosis.
Codes
• Gout – (acute) (attack) (flare) M10.9 (ICD-10 Code Lookup, 2019).
• CPT codes- (AAPC, 2023).
• CPT code- 99214 - Office visit, established patient.
• CPT code 36415 – routine venipuncture.
• CPT code 20610- arthrocentesis, aspiration and/or injection, major joint or bursa: without
ultrasound.
, • CPT code 89060- Crystal identification by light microscopy with or without polarizing
lens analysis, tissue, or any body fluid.
Guidelines- 2020 American College of Rheumatology Guideline for the Management of Gout
(FitzGerald et al., 2020) (American College of Rheumatology, 2023).
1. Treatment of acute gout episode- Pharmacological- Nonsteroidal anti-inflammatory drugs
(NSAIDs), corticosteroids, or colchicine, are recommended first-line treatments for gout
flare-ups (FitzGerald et al., 2020).
• NSAID- Naproxen 500mg po bid with food, x 7 days, #30, for pain and
inflammation, monitor for bleeding, ulcers. Reduce to Naproxen 250mg bid for
prophylaxis for 3-6 months.
• Corticosteroid -Prednisone 10mg tabs, 3 tabs (30mg) po qd with food x 5 days,
#15, for inflammation- monitor for mood changes, elevated BP.
• Colchicine – 0.6mg, 2 tabs (1.2mg) po x 1 followed by one tab (0.6mg) po after
one-hour, #3, – monitor for n/v/diarrhea, avoid grapefruit products. Reduce to
colchicine 0.5mg po qd for prophylaxis for 3-6 months.
• Management to prevent recurrent flare-ups
o Start allopurinol to prevent flare-ups 2-3 weeks after acute attack (American
College of Rheumatology, 2023). Allopurinol 100mg, one po qd, incr. 100
mg/day q2wks until uric acid <6 mg/dL, #45. Take with a full glass of water,
take with food if upset stomach. Monitor kidney and liver function, monitor
for painful rash,(Stevens-Johnson Syndrome), bloody urine, signs of infection,
and liver problems.
2. Non-Pharmacological (American College of Rheumatology, 2023).
• Low purine diet, decrease consumption of red meat, seafood
