Which specialist treats gout?

Rheumatologists Are the Specialists Who Treat Gout

Rheumatologists are the medical specialists who should evaluate and manage patients with gout due to their expertise in inflammatory joint diseases and crystal arthropathies 1.

Why Rheumatologists for Gout Management

Rheumatologists are uniquely qualified to manage gout for several important reasons:

1. Diagnostic Expertise: Rheumatologists are trained in the definitive diagnosis of gout through:

   • Identification of monosodium urate (MSU) crystals from joint fluid or tophi aspirates
   • Recognition of classical clinical features like podagra and tophi
   • Interpretation of advanced imaging techniques like ultrasound and dual-energy CT 1

2. Treatment Expertise: Rheumatologists have specialized knowledge in:

   • Managing acute gout attacks with appropriate medications
   • Implementing long-term urate-lowering therapy (ULT)
   • Preventing flares during ULT initiation
   • Monitoring treatment efficacy and adjusting therapy accordingly 1

3. Comorbidity Management: Rheumatologists understand the important relationship between gout and:

   • Renal disease
   • Cardiovascular conditions
   • Metabolic syndrome
   • Medication interactions 1, 2

Treatment Approach by Rheumatologists

Rheumatologists follow evidence-based approaches to gout management:

For Acute Attacks:

• Low-dose colchicine (up to 2mg daily)
• NSAIDs
• Glucocorticoids (intra-articular, oral, or intramuscular) 1

For Long-term Management:

• Allopurinol as first-line urate-lowering therapy
• Alternative options including febuxostat and uricosurics when indicated
• Target serum urate level below 6 mg/dL (0.36 mmol/L) 1, 3
• More aggressive target (below 5 mg/dL or 0.30 mmol/L) for patients with tophi 1

When to Consult a Rheumatologist

While primary care physicians often manage uncomplicated gout, referral to a rheumatologist is particularly important for:

• Diagnostic uncertainty requiring crystal identification
• Tophaceous gout
• Refractory cases not responding to standard therapy
• Patients with significant comorbidities affecting treatment choices
• Need for advanced therapies like pegloticase 2, 4

Common Pitfalls in Gout Management

Rheumatologists help avoid common pitfalls in gout care:

• Diagnostic errors: Only 8% of ED visits for suspected gout include arthrocentesis for crystal confirmation 5
• Inadequate acute treatment: Over 50% of ED visits for acute gout do not include administration of anti-inflammatory medications 5
• Poor long-term management: Many patients fail to receive appropriate urate-lowering therapy or monitoring
• Medication non-adherence: Rheumatologists emphasize the importance of medication adherence for this chronic condition 4

Rheumatologists provide comprehensive care for gout patients, from accurate diagnosis through effective long-term management, significantly improving outcomes and quality of life.