From the Guidelines
Gout diagnosis relies primarily on joint fluid analysis to identify monosodium urate crystals, which is the gold standard test. Additional diagnostic tools include serum uric acid levels (typically elevated above 6.8 mg/dL), inflammatory markers like ESR and CRP, and imaging studies such as X-rays, ultrasound, or dual-energy CT to detect tophi and joint damage.
Diagnostic Tests for Gout
- Joint fluid analysis for monosodium urate crystals
- Serum uric acid levels
- Inflammatory markers like ESR and CRP
- Imaging studies such as X-rays, ultrasound, or dual-energy CT Management of acute gout attacks focuses on anti-inflammatory medications including NSAIDs (naproxen 500mg twice daily or indomethacin 50mg three times daily for 3-5 days), colchicine (1.2mg initially, followed by 0.6mg one hour later, then 0.6mg once or twice daily until symptoms resolve), or corticosteroids (prednisone 30-40mg daily, tapered over 7-10 days) 1.
Management of Acute Gout Attacks
- NSAIDs (naproxen 500mg twice daily or indomethacin 50mg three times daily for 3-5 days)
- Colchicine (1.2mg initially, followed by 0.6mg one hour later, then 0.6mg once or twice daily until symptoms resolve)
- Corticosteroids (prednisone 30-40mg daily, tapered over 7-10 days) For long-term management, urate-lowering therapy is recommended for patients with frequent attacks, tophi, joint damage, or kidney stones. First-line options include allopurinol (starting at 100mg daily, gradually increasing to achieve target uric acid levels below 6 mg/dL) or febuxostat (40-80mg daily) 1.
Long-term Management of Gout
- Urate-lowering therapy for patients with frequent attacks, tophi, joint damage, or kidney stones
- First-line options: allopurinol (starting at 100mg daily) or febuxostat (40-80mg daily) Lifestyle modifications are also important, including weight loss if overweight, limiting alcohol (especially beer), avoiding high-purine foods like organ meats and shellfish, and maintaining adequate hydration. Prophylactic therapy with low-dose colchicine (0.6mg daily) or NSAIDs may be used when initiating urate-lowering therapy to prevent flares during the first 3-6 months of treatment 1.
Lifestyle Modifications and Prophylactic Therapy
- Weight loss if overweight
- Limiting alcohol (especially beer)
- Avoiding high-purine foods like organ meats and shellfish
- Maintaining adequate hydration
- Prophylactic therapy with low-dose colchicine (0.6mg daily) or NSAIDs to prevent flares during the first 3-6 months of treatment
From the FDA Drug Label
As a result of xanthine oxidase inhibition, the serum concentration of hypoxanthine plus xanthine in patients receiving allopurinol tablets for treatment of hyperuricemia is usually in the range of 0.3 to 0.4 mg/dL compared to a normal level of approximately 0.15 mg/dL. Gout is a metabolic disorder which is characterized by hyperuricemia and resultant deposition of monosodium urate in the tissues, particularly the joints and kidneys. Allopurinol tablets reduce both the serum and urinary uric acid levels by inhibiting the formation of uric acid The upper limit of normal is about 7 mg/dL for men and postmenopausal women and 6 mg/dL for premenopausal women.
The diagnostic tests for gout include:
- Serum uric acid level: to check for hyperuricemia
- Urine test: to measure uric acid excretion
- Joint fluid test: to check for urate crystals The management options for gout include:
- Allopurinol tablets: to reduce serum and urinary uric acid levels
- Uricosuric agents: to increase urinary excretion of uric acid
- Dietary changes: to reduce animal protein, sodium, refined sugars, oxalate-rich foods, and excessive calcium intake
- Increased fluid intake: to help reduce uric acid levels 2, 2, 2
From the Research
Diagnostic Tests for Gout
- Gout is typically diagnosed using clinical criteria from the American College of Rheumatology 3
- Diagnosis may be confirmed by identification of monosodium urate crystals in synovial fluid of the affected joint 3
- Arthrocentesis should be performed when suspicion for an underlying septic joint is present; synovial fluid or tophus analysis should be performed if the diagnosis is uncertain 4
- Diagnosis of gout can be made using several validated clinical prediction rules 4
Management Options for Gout
- Acute gout may be treated with nonsteroidal anti-inflammatory drugs, corticosteroids, or colchicine 3
- Non-steroidal anti-inflammatory drugs (NSAIDs) are commonly used to treat acute gout 5
- Colchicine, nonsteroidal anti-inflammatory drugs, and corticosteroids relieve pain in adults with acute gout episodes 4
- Allopurinol and febuxostat are first-line medications for the prevention of recurrent gout 3, 6
- Uricosuric drugs, such as probenecid, increase uric acid excretion 6
- Patients receiving urate-lowering medications should be treated concurrently with nonsteroidal anti-inflammatory drugs, colchicine, or low-dose corticosteroids to prevent flares 3
Lifestyle Modifications for Gout Management
- Patients should limit their consumption of certain purine-rich foods (e.g., organ meats, shellfish) and avoid alcoholic drinks (especially beer) and beverages sweetened with high-fructose corn syrup 3
- Consumption of vegetables and low-fat or nonfat dairy products should be encouraged 3
- Obesity, alcohol intake, and certain foods and medications can contribute to hyperuricemia, and these potentially exacerbating factors should be identified and modified 7