Management of gout: Primary care approach

Great strides have been made in understanding gout as a disease over the centuries. Despite these advances, reports suggest that the management of gout is relatively suboptimal at the primary care level. This article reviews important considerations in the management of gout and provides an evidence-based approach for the management of acute and chronic gouty arthritis at the primary care level. Recurrent monoarticular pain and swelling should raise the suspicion of gout and the demonstration of urate crystals in synovial fluid during a clinical episode confirms the diagnosis. Acute gouty attacks should be managed with appropriate doses of non-steroidal anti-inflammatory drugs (NSAIDs) or colchicines or steroids. Recurrent attacks of gout, presence of tophi and urate stones necessitate urate-lowering drugs. Prophylactic anti-inflammatory agents for up to six months should be added at initiation of urate-lowering therapy to reduce flares of acute attacks. Gout management requires lifelong commitment and adherence to lifestyle modification and treatment improves clinical outcomes.