Gout flare in the critical care setting: diagnostic challenges and treatment options

Abstract

Gout is the most common form of crystal-induced arthritis. Gout flares are a frequent complication during hospital admissions, including the critical care settings. Inpatient gout flare is a multifactorial event influenced by a combination of gout-and hospitalization-related factors. Several factors can trigger gout flares through altered renal urate handling, serum urate fluctuation, and macrophage priming. Early detection of gout flares can aid in the reduction of unnecessary antibiotics use, laboratory investigations, and diagnostic procedures, leading to improved hospital outcomes. Identification of crystals in synovial fluid or tophi is the gold standard for gout diagnosis, but the procedure is sometimes contraindicated in the critical care setting. Hospitalized patients with gout usually have multiple comorbidities contributing to challenges in the management of gout flares, which are not present in outpatient or noncritical inpatient settings. In this review, we discuss the unique characteristics and impact of gout flares in the critical care setting, as well as the diagnostic challenges and options for the treatment of gout flares and hyperuricemia in this setting.