The British Society for Rheumatology Guideline for the Management of Gout

Latest guidance on the management of gout

“…The single most important risk factor is sustained hyperuricaemia, which can be caused by overproduction or underexcretion of urate 23. Pathological hyperuricaemia has been defined as the serum uric acid concentration (408 μmol/L) above which monosodium urate crystals form in vitro at physiological pH and temperature.…”

“…For most people with gout, underexcretion is the main cause of hyperuricaemia. Other factors associated with the development of gout include drugs (such as diuretics, ciclosporin, and low dose aspirin), renal impairment, excessive consumption of red meat or seafood, fructose-sweetened drinks, and alcohol (in particular, beer and spirits) 234…”

“…There is limited evidence that weight loss is associated with a small reduction in serum uric acid levels 89. Guidelines recommend that patients are provided with appropriate lifestyle advice on exercise, weight management, and healthy eating aimed at reducing cardiovascular risk and other related comorbidities 210…”

“…Treatment for an acute attack should be started as soon as possible 21011. Non-steroidal anti-inflammatory drugs (NSAIDs) and colchicine are recommended as first line treatment options for an acute attack, with systemic corticosteroids generally restricted to those people who don’t respond to, or cannot tolerate, NSAIDs or colchicine 21012…”

“…Gout is the most common inflammatory arthritis and its incidence in the UK has steadily increased from 1.5% in 1997 to 2.5% in 2012 12. It is characterised by deposition of monosodium urate crystals in joints and tissues and usually presents with intermittent painful attacks followed by long periods of remission 3.…”