Gout

Abstract

Key Clinical Points

Gout

Although the presence of monosodium urate crystals in aspirates obtained from joints, bursa, or tophi remains the reference standard, a clinical diagnosis of gout can be made on the basis of the presence of suggestive clinical features.

When feasible, patients should keep medication on hand (the “pill-in-a-pocket” approach) to facilitate early antiinflammatory treatment of gout flares.

Allopurinol represents the first line of therapy to lower urate concentrations and should be administered according to a treat-to-target approach (initial low doses followed by gradual dose escalation) to establish and maintain serum urate concentrations below 6.0 mg per deciliter.

Treatment for gout must be individualized to account for coexisting cardiometabolic and renal conditions, which are often overrepresented in this patient population.

Although potentially beneficial in the management of associated conditions, dietary and lifestyle modifications alone are seldom adequate interventions for lowering urate concentrations.