Gout: a microcrystalline arthritis

Urate crystal deposits

Gout results from hyperuricemia leading to monosodium urate crystal deposits in joints. Mainly affects men >40 years and postmenopausal women.

Acute attack

Sudden onset, often nocturnal. Big toe (podagra), knee, ankle: red, hot, swollen, very painful joint. Trigger: food/alcohol excess, dehydration, certain medications (diuretics).

Treatment of attack

Colchicine, NSAIDs, oral or intra-articular corticosteroids. Anti-IL-1 (anakinra, canakinumab) if contraindications.

Long-term treatment

• Indications: at least 2 attacks/year, tophi, joint damage, urate nephrolithiasis
• Allopurinol: first-line, gradual titration
• Febuxostat if intolerance/insufficiency
• Probenecid uricosuric
• Target: uric acid <360 µmol/L (<300 if tophi)

Diet

Limit red meat, organ meats, shellfish, beer, sugary drinks. Promote: low-fat dairy, cherries, water, coffee.