Overview of Gout
3
Figure 1. Management of Gout
Recommendations for ALL Patients with Diagnosis of Gout (C)
• Evaluate current burden and future potential of gout disease (measure uric acid,
evaluate for risk factors for hyperuricemia, evaluate severity and frequency of acute
gout attacks, examine for palpable tophi)
• Educate patient on diet and lifestyle (See Figure 3)
• Consider secondary causes of hyperuricemia (See Table 1)
• Eliminate or substitute non-essential prescription medications that induce
hyperuricemia
a
(See Figure 1 continued)
Evaluate Indications for Urate-Lowering erapy (ULT)
Any patient with established diagnosis of gouty arthritis and
• Tophus or tophi on clinical exam or imaging study (A)
• Frequent attacks of acute gouty arthritis (≥2 attacks/yr) (A)
• CKD stage 2 or worse (C)
• Past urolithiasis (C)
If Ongoing Pharmacologic ULT is indicated
DEFINE SERUM URATE TARGET GOAL
• <6 mg/dl for ALL patients on ULT
• <5 mg/dl for patients with "complicated gout"
(as defined by refractory, severe acute attacks or
severe tophaceous burden – See Figure 2)
• Begin ULT + concomitant antiinflammatory
prophylaxis against acute gout attacks
Begin First Line ULT agent
Allopurinol
(See Table 2a)
Febuxostat
OR
Alternative First Line ULT:
Probenecid
b
(B)
(See Table 2b)
If at least one XOI is contraindicated or not tolerated
Xanthine Oxidase Inhibitor (XOI): (A)
Acute Gout Prophylaxis
(A)
(See Figure 4)
TREAT TO
TARGET
Serum urate target
achieved?
Increase intensity of ULT
Re-evaluate serum urate
(See Table 3)
Long-Term Management of Gout
(See Figure 1 continued)
Establish Diagnosis of Gout
Re-evaluate
need for ULT as
clinical symptoms
of gout change
Allopurinol is the most commonly used ULT agent.
NO YES
+
