Authors' objectives: Gout is the most common form of inflammatory arthritis and is characterized by acute intermittent episodes of synovitis presenting with joint swelling and pain (referred to as acute gouty arthritis, or acute gout attacks, or acute gout flares). It has been described as a disease of the foot since antiquity. Approximately 8 million patients in the United States have gout. Gout is caused when excess urate in the body crystalizes (as monosodium urate [MSU]) in joint fluid, cartilage, bones, tendons, bursas or other sites. These crystals can directly stimulate an acute inflammatory attack. In some patients, acute gout attacks become progressively more frequent, protracted, and severe and may eventually progress to a chronic inflammatory condition. Additionally, in some patients the deposits of urate crystals grow into larger collections, called tophi (singular tophus) when clinically apparent. The aim of this report is to review the evidence for the treatment of patients with gout, focusing on the primary care setting.

Authors' recommendations: Several drugs show moderate-to-high evidence of benefit in terms of reducing pain in patients with acute gout. It is clear that urate lowering therapy achieves its goal of lowering urate levels. Decreased serum urate should lead, over time, to a reduction in gout attacks, but the benefits and harms of long term urate lowering therapy have yet to be demonstrated directly. Patient preferences are likely to be important in decision-making (as specified above), and having better estimates of the size of the benefit of urate lowering therapy will make clinicians and patients more knowledgeable about the risk: benefit trade-off for the different decisions.

Project Status: Completed

Year Published: 2016

URL for published report: https://www.effectivehealthcare.ahrq.gov/ehc/products/564/2195/gout-management-report-160314.pdf

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: United States

Organisation Name: Agency for Healthcare Research and Quality

Contact Address: Center for Outcomes and Evidence Technology Assessment Program, 540 Gaither Road, Rockville, MD 20850, USA. Tel: +1 301 427 1610; Fax: +1 301 427 1639;

Contact Name: martin.erlichman@ahrq.hhs.gov

Contact Email: martin.erlichman@ahrq.hhs.gov

Copyright: Agency for Healthcare Research and Quality (AHRQ)