Qaseem A et al. Ann Intern Med. 2016 - doi:10.7326/M16-0570
This article was published at www.annals.org on 1 November 2016
"Gout, one of the most common forms of inflammatory arthritis, is caused by accumulation of excess urate crystals (monosodium urate) in joint fluid, cartilage, bones, tendons, bursas, and other sites. Patients experience joint swelling and pain during gout attacks, known as acute gouty arthritis. In some patients, the frequency and duration of acute attacks increase over time and lead to chronic gout, which may be associated with deposits of uric acid crystals known as tophi. Risk factors for gout include overweight or obesity; hypertension; alcohol intake; diuretic use; a diet rich in meat, seafood, and high-fructose food or drinks; and poor kidney function (1–4). About 3.9% of U.S. adults older than 20 years report being told at some point that they had gout (5). This percentage increased by about 1% in the 10 years before 2007, probably because of a parallel increase in conditions associated with hyperuricemia. An estimated $1 billion is spent annually on ambulatory care for gout, largely on treatments and prescription medications (6).
Management of gout includes both pharmacologic and nonpharmacologic approaches. Pharmacologic therapies focus on urate-lowering strategies and anti-inflammatory drugs (Table 1). Nonpharmacologic management focuses on dietary and lifestyle changes, including weight loss and exercise..."