Gout: diagnosis and management

Context

Gout is a type of arthritis caused by monosodium urate crystals forming inside and around joints, resulting in sudden flares of severe pain, heat and swelling. Any joint can be affected but gout is most common in distal joints, such as big toes, knees and ankles, and fingers.

Between 2 and 3 in every 100 people in the UK have gout. It usually occurs in men over 30 and women after menopause, and is more common in men than women. Long-term complications of gout include joint damage and renal stones. Almost 25% of people with gout have chronic kidney disease (CKD) stages 3 to 5 (glomerular filtration rate [GFR] categories G3 to G5).

Gout is most often managed in primary care without specialist rheumatological input. Flares are usually treated with non-steroidal anti-inflammatory drugs, colchicine or corticosteroids. However, most people have further flares. They can be prevented by taking medicines to reduce serum urate levels (such as allopurinol or febuxostat).

However, only one-third of people with gout have these medicines and they are used effectively (lowering serum urate level to the target) by only one-third of people who take them. People with CKD also often have contraindications to medicines used to manage gout.

Diagnosing gout and differentiating gout from other types of arthritis is not always straightforward and the best method of diagnosis is often unclear. There is a need to improve the diagnosis and management of gout and the quality of life for people with gout.