What medical specialty manages gout?

What Specialty Manages Gout

Rheumatologists are the specialty physicians who develop and lead gout management guidelines, though the American College of Rheumatology explicitly designs these guidelines for use by rheumatologists AND other healthcare providers including primary care practitioners, subspecialists, nurse practitioners, physician assistants, and allied health professionals. 1

Primary Management Structure

• The American College of Rheumatology created comprehensive gout management guidelines specifically intended for international use by both rheumatologists and non-specialist healthcare providers, recognizing that gout management occurs across multiple practice settings 1

• Primary care physicians, general internists, and family medicine practitioners commonly manage the majority of gout cases in clinical practice, as gout has been "managed primarily in general medical practices for centuries" 2

• Rheumatology consultation becomes particularly important for complex cases including refractory gout not responding to standard urate-lowering therapy, patients with multiple comorbidities complicating medication selection, chronic tophaceous gout requiring advanced therapies, or when diagnostic uncertainty exists 1

Multidisciplinary Involvement

• Nephrologists play an important role in gout management when patients have significant chronic kidney disease (CKD stage ≥3), as kidney function directly impacts medication dosing and selection of urate-lowering agents 1

• The 2020 ACR guideline development panel included rheumatologists, a general internist, a nephrologist, a physician assistant, and patient representatives, reflecting the multidisciplinary nature of gout care 1

Why This Collaborative Model Exists

• Gout affects approximately 3.9% of US adults (~8.3-9.2 million people), making it the most common inflammatory arthritis, which creates a patient volume far exceeding rheumatology capacity alone 1

• Many gout patients have complex comorbidities including hypertension, obesity, metabolic syndrome, type 2 diabetes, and chronic kidney disease that require coordination between specialties 1

• The ACR explicitly requested guidelines "useful for both rheumatologists and other health care providers on an international level" because quality of care gaps exist across all practice settings 1

Common Pitfall to Avoid

• Do not assume gout management requires automatic rheumatology referral—most uncomplicated gout can and should be managed effectively in primary care using treat-to-target strategies with allopurinol titration to achieve serum urate <6 mg/dL 1, 3