Intended for healthcare professionals

Practice 10-minute consultation

Management of recurrent gout

BMJ 2008; 336 doi: (Published 07 February 2008) Cite this as: BMJ 2008;336:329
  1. Robin Fox, GP1
  1. 1The Health Centre, Bicester OX27 0EY
  1. Robin.Fox{at}

    An overweight 60 year old man tells you he has had four episodes of gout over the past year and wants to know how to reduce the chance of further attacks. He takes amlodipine for hypertension.

    What issues you should cover

    Confirm diagnosis—Is it really gout? A typical history of rapid onset, severe, self limiting joint pain reaching its maximum over 6-12 hours, with swelling and erythema, suggests gout, particularly if it involves the first metatarsophalangeal joint at some point. (This joint is affected in 90% of cases and is the first joint affected in 70%.) The presence of tophi support the diagnosis. Previous evidence of monosodium urate crystals from a joint aspirate (during or between attacks) would be the gold standard. A concentration of serum uric acid (SUA) of ≤380 µmol/l at least one month after an acute attack or ≤330 µmol/l during an attack makes gout an unlikely diagnosis.

    Causes—Look for risk factors (see box).

    Complications—These might include renal stones, nephropathy, or tophi.

    Consider—Associated metabolic syndrome may be present.

    Risk factors for gout

    Common risk factors
    • Increasing age …

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