Update on the diagnosis and management of gout
Gout is a common clinical problem encountered by both general and specialist physicians. Despite its high prevalence and the availability of safe and effective therapies, the optimal approach to its diagnosis and treatment remains uncertain, as a result of which practice varies between clinicians.1 In this article, we provide an up-to-date review of the diagnosis and management of gout, and outline recent developments in the literature.
The key principles in gout management are:
- establishing a definitive diagnosis;
- the swift treatment of acute attacks; and
- preventing further attacks and joint damage by using urate-lowering therapies appropriately.
To establish a definitive diagnosis, monosodium urate (MSU) crystals must be demonstrated by polarised light microscopy in synovial fluid or in a tophus. A clinical diagnosis is possible without synovial fluid analysis, but must be considered only provisional. Individual clinical and laboratory features — such as hyperuricaemia, first metatarsal joint involvement, maximal inflammation within 24 hours and local erythema — are of low diagnostic utility, with two exceptions: a prompt response to colchicine (positive predictive value [PPV], 86%) and the presence of tophi (PPV, 91%).2
New imaging techniques have recently been explored as diagnostic…