Hyperuricemia and gout: new concepts in diagnosis and management

Gout is a chronic, progressive condition for which hyperuricemia is the primary risk factor. The initial episodes of gout may be brief, only lasting for 3 to 5 days, and patients may experience pain-free intercritical periods that last from months to years. However, as the disease progresses, acute gout flares become more frequent and prolonged (typically lasting ≥ 5-10 days). Chronic gouty arthritis develops, with shorter pain-free intervals; tophi become visible and interarticular joint damage occurs. Patients with advanced gout experience chronic pain and a decreased quality of life. Gout prevalence has increased significantly over time. Despite the increase in the number of gout cases, the disease is often mismanaged, especially in primary care. Hyperuricemia is inadequately controlled as a result of suboptimal dosing with urate-lowering drugs, intolerance to therapy, or poor patient compliance. This review article provides a comprehensive discussion of gout pathophysiology, risk factors, and approaches to treatment that encourage the clinician to appreciate hyperuricemia as a multifaceted disorder and manage the condition optimally.