01 / ADAPTABLE OUTLINE
What to document
Flare history
Onset, joint, prior crystal-confirmed episodes, fever, trauma, infection risk, existing urate-lowering treatment, and prior flare medicines.
Joint & systemic exam
Vitals, general appearance, site and extent of erythema, warmth, swelling, tenderness, range of motion, overlying skin, and distal function.
Differential & testing
Consider septic arthritis, other crystal arthritis, cellulitis, and trauma. Document aspiration and culture decisions when uncertainty or infection concern exists.
Flare & long-term plan
Specify the selected anti-inflammatory, dose, safety review, supportive care, reassessment, and separate follow-up for urate management.
02 / WORKED EXAMPLE
Recurrent first-MTP flare with prior crystal-confirmed gout
Illustrative documentation only. Not patient data, a treatment protocol, or a complete billing checklist.
History
A 52-year-old patient reports eight hours of right great-toe joint pain similar to previous crystal-confirmed gout flares. No fever, wound, recent procedure, or trauma is reported. The patient has not taken colchicine for this episode. Current medicines and kidney and liver history were reviewed.
Examination & assessment
The patient is afebrile and systemically well. The right first MTP is warm, swollen, and tender without an overlying wound or spreading erythema. Findings support recurrent gout. Infection remains a reconsideration if the clinical course is atypical or fails to improve.
Plan
After confirming appropriate renal and hepatic function and absence of relevant interactions, prescribe colchicine 1.2 mg orally once, then 0.6 mg one hour later for this flare. Discussed adverse effects and avoiding extra doses without review. Relative rest and wrapped cold packs discussed. Reassess within 48–72 hours if not improving; seek urgent evaluation for fever, spreading redness, systemic illness, or worsening joint pain. Arrange primary care review of recurrent flares and urate-lowering needs.
A common documentation question
Should diet be included in the gout plan?
Yes, when discussed. Record realistic changes and the patient's priorities without implying diet alone will control recurrent gout or replace indicated medication.
03 / CLINICAL REASONING
Differential & testing considerations
Examples to consider—not diagnoses to automatically include in a note.
Differential
- Gout flare
- Septic arthritis — may coexist with crystals
- CPP crystal arthritis
- Cellulitis or traumatic injury
Testing & assessment
- Consider joint aspiration with crystal analysis, cell count, and culture when diagnosis is uncertain or infection is suspected.
- Review renal/hepatic status and interacting medicines before choosing treatment.
04 / TREATMENT & DOSAGE REFERENCES
Make the plan specific.
Selected adult references, not a complete protocol or individualized prescription. Check the indication, formulation, allergies, pregnancy, renal/hepatic function, interactions, and current local guidance. Sources checked September 10, 2026.
Colchicine — adult acute flare reference
1.2 mg orally at flare onset, then 0.6 mg one hour later (1.8 mg total for this regimen).
This is not the prophylaxis regimen. Do not keep repeating doses for pain; repeat-course timing and renal/hepatic adjustments require separate review.
Safety review: Potentially fatal interactions occur with P-gp/strong CYP3A4 inhibitors, particularly with renal or hepatic impairment. Check the full label for dose adjustments, contraindications, and concurrent prophylaxis.
DailyMed: colchicine prescribing information ↗Other flare options & prevention
NSAIDs or glucocorticoids are alternatives selected by comorbidities and contraindications, not automatic additional medicines. Discuss limiting alcohol, high-purine foods, and high-fructose drinks, and weight management where appropriate. Diet is an adjunct, not a substitute for indicated urate-lowering therapy.
ACR: 2020 gout management guideline ↗