An update on the management of gout

Gout is the most common form of inflammatory arthritis and its incidence in the UK has steadily increased from 1.5% in 1997 to 2.5% in 2012.^1,2 It is characterised by deposition of monosodium urate crystals in joints and tissues and usually presents with intermittent painful attacks followed by long periods of remission.³ It has been suggested that the management of gout in the UK remains suboptimal.¹ In 2004, we concluded that there was a woeful lack of evidence to guide treatment or prophylaxis for gout, particularly with regard to choice of drug or doses.⁴ The introduction of new drugs and new evidence on the efficacy and safety of treatment options has led the European League Against Rheumatism (EULAR) and the British Society of Rheumatology (BSR) to update their guidelines on the management of gout.^2,5 Nevertheless, there are differing views on target serum uric acid (SUA) levels and the role of urate lowering treatment (ULT).^2,5-7 Here, we review the latest guidance on the management of gout and consider the role of long-term ULT.