The Curbsiders Internal Medicine Podcast #489 Live from SHM #Converge2025 Rheumatology for the Hospitalist
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Jun 30, 2025 
Dr. Kimberly Trotter, an Assistant Professor of Medicine at the University of Chicago and co-director of the Lupus Center, dives into the world of rheumatology, specifically focusing on crystalline arthropathies. She discusses diagnosing gout, including the critical use of uric acid levels and arthrocentesis. Trotter shares insights on effective acute treatments and emphasizes the importance of long-term management and patient education to prevent future flare-ups. Her expertise sheds light on the challenges faced by hospitalists in tackling these conditions.
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Differential Diagnosis for Acute Monoarthritis
- Always consider gout first in acute monoarthritis cases, especially with first toe involvement (podagra).
- Differentiate gout from pseudogout, osteoarthritis, infection, and trauma in your differential diagnosis.
Importance of Joint Aspiration
- Always try to aspirate the joint to confirm gout diagnosis, especially for first flares or new monoarthritis.
- Defer arthrocentesis in patients with known gout and typical recurrent flares affecting multiple joints.
Limitations of Uric Acid During Flares
- Uric acid levels can be falsely low during an acute gout flare.
- Baseline uric acid levels are useful for long-term management but not diagnostic during flares.