Gout
Summary
Gout is an inflammatory arthritis caused by deposition of monosodium urate crystals in joints and soft tissues. It presents as acute attacks of severe joint pain, swelling, and erythema, classically affecting the first MTP joint. Diagnosis is confirmed by identification of negatively birefringent crystals on joint aspiration. Management involves treating acute attacks (NSAIDs, colchicine, steroids) and long-term urate-lowering therapy (allopurinol) to prevent recurrence.
Key Facts
- Definition: Crystal arthropathy from urate deposition
- Incidence: 1-2% of adults; increasing
- Pathognomonic: Negatively birefringent needle-shaped crystals
- Gold Standard Investigation: Synovial fluid microscopy
- First-line Treatment: NSAIDs/colchicine/steroids acutely; allopurinol long-term
- Prognosis: Excellent with proper management
Clinical Pearls
Crystal Pearl: Negatively birefringent, needle-shaped - gout. Positive, rhomboid - pseudogout.
Allopurinol Pearl: Don't start during acute attack; start low (100mg) and titrate.
Target Pearl: Aim for urate less than 360 (less than 300 if tophi).
- Obesity
- Alcohol (especially beer)
- Purine-rich diet
- Diuretics
- Renal disease
- Genetics
Algorithm
Acute Attack
| Drug | Dose |
|---|---|
| Naproxen | 500mg BD |
| Colchicine | 500mcg BD-TDS |
| Prednisolone | 30-40mg OD if NSAIDs contraindicated |
Long-term ULT
| Drug | Dose |
|---|---|
| Allopurinol | Start 100mg, titrate to target urate |
| Febuxostat | Alternative if allopurinol intolerant |
Prophylaxis
- Colchicine 500mcg OD-BD for 6 months when starting ULT
-
BSR/BHPR. UK Guideline for the Management of Gout. 2017. PMID: 28100474
-
EULAR. 2016 updated recommendations for the management of gout. Ann Rheum Dis. 2017;76(1):29-42. PMID: 27457514
Viva Points
"Gout: negatively birefringent crystals. Acute: NSAIDs/colchicine/steroids. Long-term: allopurinol, target urate less than 360. Don't start ULT during attack. Colchicine cover when starting."
Last Reviewed: 2026-01-01 | MedVellum Editorial Team