Overview
Gout is an inflammatory disease characterized by the deposition of monosodium urate (MSU) crystals in joints, cartilage, synovial bursa, tendons, or soft tissues 1. It is associated with various comorbidities, including cardiovascular diseases, chronic kidney disease, and diabetes mellitus 1.Diagnosis
Diagnosis is based on the presence of MSU crystals in synovial fluid or tophi 1.Management
Long-term urate-lowering treatment (ULT) is recommended for patients with hyperuricemia and previous episodes of acute gouty arthritis to prevent recurrent attacks and complications 1.
ULT should be used during inter-critical and chronic stages to prevent recurrent gout attacks and promote tophi resolution 1.
The target serum uric acid (sUA) level for ULT is <6.0 mg/dL 1.
For patients with tophi, the initial goal for sUA lowering can be set at <5.0 mg/dL to promote tophi dissolution 1.Key Recommendations
Patients with hyperuricemia and previous episodes of acute gouty arthritis should receive long-term urate-lowering treatment to prevent recurrent gout attacks and complications 1. (Evidence: Expert opinion)
Urate-lowering drugs should be used during the inter-critical and chronic stages to prevent recurrent gout attacks and may elicit gradual resolution of tophi 1. (Evidence: Expert opinion)
The goal of urate-lowering therapy should aim to maintain serum uric acid (sUA) level <6.0 mg/dL 1. (Evidence: Expert opinion)
For patients with tophi, the initial goal can be set at lowering sUA to <5.0 mg/dL to promote tophi dissolution 1. (Evidence: Expert opinion)References
1 Yu KH, Chen DY, Chen JH, Chen SY, Chen SM, Cheng TT et al.. Management of gout and hyperuricemia: Multidisciplinary consensus in Taiwan. International journal of rheumatic diseases 2018. link