Rheumatology

Answer 5 Start antibiotics. Although it appears that this patient has acute gout, infection should be carefully considered, particularly because there is no prior history of an acute inflamed bursa or joint. If the results of culture rule out infection, then the olecranon bursa can be injected safely with steroids to help minimize pain and swelling. Oral colchicine can be administered concurrently with antibiotic treatment; however, many rheumatologists avoid aggressive colchicine treatment due to the side effects (ie, diarrhea).5 Allopurinol should not be started during an acute attack because it can prolong or worsen the attack. REFERENCES 5. Morris I, Varughese G, Mattingly P. Colchicine in acute gout. BMJ 2003;327:1275-6. Click here to return to the questions

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