Gout Practice Pearls

  1. Gout is a metabolic condition associated with an elevated uric acid burden which manifests itself as a chronic inflammatory arthritic disease.
  2. Gout is characterized by acute, extremely painful attacks/flares (seen, i.e. hot toe) on the backbone of an underlying chronic metabolic defect (the unseen, i.e. silent complications)
  3. Urate crystals and subclinical tophi can be found in joints in the absence of clinical symptoms.
  4. A diagnosis of gout is usually a presumptive diagnosis that considers patient history including risk factors and comorbidities as well as evidence from the physical exam (painful/swollen joint, tophi) and labs (sUA levels posts-flare)
  5. Treatment of acute glout flares invlovesthe early initiation of anti-inflammatory therapy to target the cascade of inflammatory events initiated by the urate crystals.
  6. Anti-inflammatory agents do not treat the underlying cause of the disease.
  7. NSAIDs and colchicines provides similar efficacy outcomes in the treatment of an acute flare and should be used as first-line agents. Opioids have a role in the management of pain from an acute flare up and may be especially useful if NSAIDs/Coxibs are contraindicated.
  8. Treatment for chronic gout involves sUA lowering therapy to protect against future gout flares and to minimize or reverse joint, bone and soft tissues damage.
  9. Diet and lifestyle adjustments will help prevent gout attacks, prevent the depositions of urate crystals, as well as preventing complications of gout and its associated comorbidities including cardiovascular-metabolic issues.
  10. Poor management of gout and acute gout flares causes significant impact on a patient's quality of life and productivity.