Gout

Summary Gout is a chronic disease of deposition of monosodium urate crystals, which form in the presence of increased urate concentrations. Although environmental factors contribute to hyperuricaemia, renal and gut excretion of urate is central to regulation of serum urate, and genetic factors are i...

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Bibliographic Details
Published inThe Lancet (British edition) Vol. 388; no. 10055; pp. 2039 - 2052
Main Authors Dalbeth, Nicola, Prof, Merriman, Tony R, Prof, Stamp, Lisa K, Prof
Format Journal Article
LanguageEnglish
Published England Elsevier Ltd 22.10.2016
Elsevier Limited
Subjects
Arthritis
Chronic Disease
Crystals
Diagnosis, Differential
Environmental factors
Genetic factors
Gout - diagnosis
Gout - drug therapy
Gout - epidemiology
Gout - physiopathology
Gout Suppressants - therapeutic use
Humans
Incidence
Inflammation
Internal Medicine
Prevalence
Risk Factors
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Summary:Summary Gout is a chronic disease of deposition of monosodium urate crystals, which form in the presence of increased urate concentrations. Although environmental factors contribute to hyperuricaemia, renal and gut excretion of urate is central to regulation of serum urate, and genetic factors are important. Activation of the NLRP3 inflammasome and release of interleukin 1β have key roles in initiation of acute gout flares. A “treat to target serum urate” approach is essential for effective gout management; long-term lowering of serum urate to less than 360 μmol/L leads to crystal dissolution and ultimately to suppression of flares. An allopurinol dose-escalation strategy is frequently effective for achieving treatment targets, and several new urate-lowering drugs are also available. Worldwide, rates of initiation and continuation of urate-lowering therapy are very low, and, consequently, achievement of serum urate targets is infrequent. Strategies to improve quality of gout care are needed.
ISSN:0140-6736
1474-547X
DOI:10.1016/S0140-6736(16)00346-9