Hot Topics in Primary Care: Update on the Recognition and Management of Gout: More Than the Great Toe

Gout is a chronic inflammatory condition that is increasing in prevalence and commonly associated with other chronic diseases such as obesity, diabetes mellitus, hypertension, hypercholesterolemia, chronic kidney disease, cardiovascular disease, and thromboembolic disorders. These associations make the management of patients with gout more complex. Although identification of MSU crystals in synovial fluid is diagnostic, a presumptive diagnosis of gout can be made clinically based on the presence of hyperuricemia, rapid development of pain, tenderness, and swelling in a single toe (male) or elbow or finger joint (female), and family history. Gout is increasingly recognized as a heterogeneous disease requiring individualized treatment. A healthy lifestyle is always recommended and patient education is critical to support self-management and long-term adherence. Antiinflammatory therapy, typically colchicine or an NSAID, is recommended for management of an acute gout flare, while ULT may be used in patients with frequent or severe acute gout, tophi, urolithiasis, renal function impairment, or other complications of gout. Allopurinol is first-line ULT for most patients, although febuxostat and probenecid are effective options and pegloticase is useful in selected patients. New medications, such as lesinurad, are on the horizon.