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George Ho, Jr, MD; Marc DeNuccio, DO

Arch Intern Med. 1993;153(24):2787-2790.

Abstract
Background
We determined the clinical characteristics of acute gout and pseudogout in hospitalized patients and examined the morbidity of inappropriate treatment and misdirected investigation when the diagnosis of acute crystal-induced synovitis was delayed.

Patients and Methods
We reviewed the medical records of 67 hospitalized adults seen in consultation consecutively by one hospital-based rheumatologist during a 64-month period between 1986 and 1991 with the diagnosis of acute gout or pseudogout.

Results
Gout was diagnosed in 41 patients, pseudogout in 24, and both crystal-induced diseases in two. The average age was 75.3 years. Polyarticular disease was common in both gout (49%) and pseudogout (42%). Fever attributable to synovitis was present in 34% of the patients and was more prevalent in patients with polyarticular (50%) than monoarticular (20%) inflammation. A quarter of the patients encountered errors in diagnosis, treatment, or both before rheumatologic consultation. Eleven patients experienced delays in diagnosis, and six patients had the correct diagnosis but received ineffective treatment.

Conclusions
Fever and polyarticular arthritis are noteworthy features in the hospitalized patient with acute gout or pseudogout. When the diagnosis of crystal-induced synovitis is overlooked, misdirected investigation and inappropriate treatment compound the morbidity of continued pain.

(Arch Intern Med. 1993;153:2787-2790)

Author Affiliations
From the Department of Medicine, The Miriam Hospital, Brown University School of Medicine, Providence, RI. Dr Ho is now with the Iowa Medical Clinic PC, Cedar Rapids.

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