Content area

Full text

Gout, caused by monosodium urate crystal deposition in joints and tissues, is commonly encountered in primary care. This article provides a review of patient-oriented evidence to guide the diagnosis and management of gout.

SORT: TABLE OF KEY CLINICAL RECOMMENDATIONS

Clinical recommendation Evidence rating Comments
Lifestyle modifications to prevent recurrent gout include reducing the consumption of high-fructose soft drinks, fruit juices, fruits, and purine-rich foods (e.g., anchovies, sardines, scallops, mussels, bacon, beef, liver, turkey, veal, venison).14 C Systematic review of mostly observational studies
A validated clinical prediction rule (Table 3) should be used to determine the likelihood of gout based on the presence of typical signs and symptoms and the uric acid level.17 C Limited quality, patient-oriented evidence, individual validation trial
Nonsteroidal anti-inflammatory drugs and corticosteroids are equally effective for the treatment of acute gout, with no significant difference in pain relief or adverse effects.34 B Limited quality, patient-oriented evidence, individual randomized controlled trial
In acute gout, low-dose colchicine (1.2 mg followed by 0.6 mg in 1 hour) is as effective as high-dose colchicine (1.2 mg followed by 0.6 mg every hour for 6 hours) with fewer adverse effects.35 B Limited-quality, patient-oriented evidence, individual randomized controlled trial
Allopurinol is the preferred first-line urate-lowering therapy to prevent recurrent gout. It is as effective as febuxostat (Uloric) in preventing gout flare-ups; however, febuxostat increases all-cause and cardiovascular mortality.41,42 A Good-quality, patient-oriented evidence, individual randomized controlled trial
The allopurinol hypersensitivity assay, or HLA-B*58:01 test, should be considered in select patients (Korean adults with stage 3 or higher chronic kidney disease and all adults of Han or Thai descent) before initiating allopurinol therapy.44 C Expert opinion, consensus guideline

A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to http://www.aafp.org/afpsort.

Epidemiology

  • In western high-income countries, the prevalence of gout is 3% to 6% in men and 1% to 3% in women.1 In 2015 and 2016, the incidence of gout was 3.9% among U.S. adults (2.7% in women and 5.2% in men).2

  • Gout is rare before the age of 20; prevalence increases linearly until plateauing after the age of 80.3

Show less