Gout

Audience: Patients and providers
Status: Clinical guide · patient + provider
Last updated: 2026-03-27

1. Clinical overview

Gout is an inflammatory crystal arthritis caused by monosodium urate deposition from chronic hyperuricemia, with separate management priorities for acute flare control and long-term urate lowering.

2. Common causes and risk factors

• Hyperuricemia from reduced renal urate excretion is common.
• CKD, diuretics, alcohol excess, obesity, metabolic disease, and high-purine dietary patterns increase risk.

3. Typical symptoms

• Sudden severe joint pain, erythema, swelling, warmth, and marked tenderness, often in the first MTP joint, ankle, foot, or knee.

4. Diagnosis and evaluation

• Confirm the flare pattern and consider aspiration when septic arthritis is a concern.
• Check flare frequency, tophi, CKD, nephrolithiasis, urate level history, and medication contributors.
• Distinguish gout from cellulitis, pseudogout, trauma, and septic arthritis.

5. Treatment (non-pharmacologic)

• Rest the involved joint, use ice if helpful, and limit alcohol excess.
• Review weight, hydration, and diet in a realistic long-term framework rather than as sole therapy.

6. Treatment (pharmacologic)

• Acute flares are commonly treated with naproxen, indomethacin, colchicine, prednisone, or intra-articular corticosteroid depending on comorbidity and timing.
• Urate-lowering therapy usually starts with allopurinol; febuxostat is an alternative when allopurinol is not tolerated or not effective.
• Prophylaxis during urate-lowering initiation commonly uses low-dose colchicine, low-dose NSAID, or low-dose prednisone when needed.

7. Monitoring and follow-up

• Track flare frequency, serum urate, medication tolerance, renal function, and adherence.
• Flare prophylaxis is often needed when urate-lowering therapy is being initiated or titrated.

8. Practical counseling points

• Explain that urate-lowering therapy prevents future flares rather than immediately treating pain.
• Warn that flares can transiently increase during early urate-lowering treatment.
• Review interactions and toxicity risks, especially with CKD and polypharmacy.

9. Red flags and escalation

• Escalate urgently for fever, inability to bear weight, atypical distribution, or concern for septic joint.
• Seek specialist input for refractory tophaceous disease, diagnostic uncertainty, or repeated intolerance to standard therapy.

10. Guideline references

• American College of Rheumatology gout guideline.
• EULAR gout recommendations.
• CKD-focused medication safety considerations where relevant.

Note: Educational guide only; not a substitute for individualized medical care.