Because of these side effects, doctors frequently choose safer medications, such as the 5-ASA drugs and antibiotics, as initial therapy. But there are a number of ways to reduce the risk of developing side effects. These include rapid but careful tapering off of steroids; alternate-day dosing; rectally applied corticosteroids; and rapidly metabolized corticosteroids such as budesonide (described above). To help prevent osteoporosis, many doctors routinely prescribe calcium supplements as well as multivitamins that contain vitamin D. Another option is the use of bisphosphonates, such as risedronate (Actonel®) and alendronate (Fosamax®). These compounds, which have been shown to help avert bone loss, are effective in treating and preventing steroid-induced osteoporosis.
Urate-lowering therapies, started six to eight after the attack has resolved, are indicated in patients who have two are more attacks per If patients are already on urate-lowering drugs, discontinuation of the drug during the acute attack is not recommended, as this will exacerbate the symptoms.
Medical treatment for pseudogout is similar to treatment for gout. Acute cases are treated with NSAIDs, plus or minus colchicine.
Cellulitis is primarily a clinical diagnosis. However, early cellulitis involving the digits is sometimes mistaken for gout.
Cellulitis should be considered in patients who have not responded to NSAIDs, colchicine, or corticosteroids. Culture and sensitivities are obtained depending on the case presentation. Treatment with antibiotics depends on the local microbial susceptibilities.
Cellulitis is sometimes misdiagnosed as gout. When in doubt, treat it as cellulitis. Use antibiotics based on local susceptibilities. This patient had cellulitis with both underlying gout and pseudogout with tophi formation. He was started on sulfasuxamide-trimethoprim double strength, naproxen sodium, oxycodone for pain, and promethazine for nausea. Follow-up general culture grew methicillin resistant Staphylococcus aureus sensitive to sulfasuxamide-trimethoprim.
Over the next seven days, our patient improved significantly.
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