Gout

SUMMARY POINTS Gout is associated with serious comorbidity and increased risk of cardiovascular disease The definitive diagnosis of gout requires microscopic identification of monosodium urate crystals A clinical diagnosis can be made when typical features of inflammation affect the first metatarsophalangeal joint; serum urate values have limited diagnostic value First line medical treatment options for acute gout are a non-steroidal anti-inflammatory drug or low dose colchicine Long term management requires full patient education, dealing with any modifiable risk factors (such as overweight or obesity, chronic diuretic intake), and urate lowering drugs Start altopurinol at a low dose (such as 100 mg daily) and increase gradually with the aim of lowering then maintaining serum urate below 360 µmol/L