From the Guidelines
Monosodium urate crystals are the primary cause of gout, and their formation can be prevented by maintaining serum uric acid levels below 6 mg/dL. The management of gout involves a multi-faceted approach, including pharmacologic and lifestyle modifications. For acute attacks, NSAIDs, colchicine (0.6mg once or twice daily), or corticosteroids are effective in relieving pain 1. Urate-lowering therapy, such as allopurinol (starting at 100mg daily and titrating up) or febuxostat (40-80mg daily), is used for long-term prevention and reduces the risk of acute gout attacks 1. Lifestyle modifications, including:
- Weight loss
- Limiting alcohol intake
- Avoiding purine-rich foods
- Adequate hydration can help reduce uric acid levels and prevent crystal formation. The goal of treatment is to maintain serum uric acid below 6 mg/dL to prevent crystal formation and recurrent attacks. Urate-lowering therapy should be started at a low dose and titrated up to achieve the target serum uric acid level 1. Prophylaxis with daily colchicine or NSAIDs can reduce the risk of acute gout attacks by at least half in patients starting urate-lowering therapy, and the duration of prophylaxis should be longer than 8 weeks 1.
From the Research
Monosodium Urate Crystals and Gout
- Monosodium urate crystals are the primary cause of gout, a common form of acute inflammatory arthritis 2, 3, 4, 5, 6
- The deposition of monosodium urate crystals in joints and other tissues leads to an acute inflammatory response and can induce permanent tissue damage 5
- Gout is characterized by painful joint inflammation, most commonly in the first metatarsophalangeal joint, resulting from the precipitation of monosodium urate crystals in a joint space 2
Diagnosis of Gout
- A definitive diagnosis of acute gout is made by detection of monosodium urate crystals in the synovial fluid of an inflamed joint 4
- Diagnosis may be confirmed by identification of monosodium urate crystals in synovial fluid of the affected joint 2
- Clinical prediction rules can also be used to diagnose gout, especially when arthrocentesis is not feasible 6
Treatment of Gout
- Acute gout may be treated with nonsteroidal anti-inflammatory drugs, corticosteroids, or colchicine 2, 3, 4, 5, 6
- Urate-lowering therapies, such as allopurinol and febuxostat, aim to prevent gout flares and are indicated for patients with chronic kidney disease, two or more flare-ups per year, urolithiasis, the presence of tophus, chronic gouty arthritis, and joint damage 2, 3, 6
- Treatment should continue for at least three months after uric acid levels fall below the target goal in those without tophi, and for six months in those with a history of tophi 2