Clinical manifestations of gout and their management

Gout is an inflammatory response to deposition of monosodium urate crystals in and around joints. It is primarily a disease of adult men. In acute gout, treatment options include non-steroidal anti-inflammatory dr ugs (NSAIDs), colchicine and corticosteroids, administered either intra-art icularly, orally or parenterally. Asymptomatic hyperuricaemia does not require specific treatment, but should prompt screening for atherosclerosis risk factors, and general lifestyle m odification to reduce serum urate levels. Gout presents differently in the elderly. Both women and men are affected, attacks are frequently polyarticular and in the upper limbs, and the gout m ay be associated with diuretic use, hypertension and renal impairment. In patients with peptic ulcer disease, selective COX-2 inhibitors provide a nother treatment option. In the presence of renal impairment, allopurinol i s the treatment of choice for urate lowering therapy, but doses of allopuri nol and colchicine must be adjusted. Urate lowering therapy should only be used if recurrent episodes of gout oc cur despite aggressive attempts to reverse or control the underlying causes . It should not be introduced or discontinued during an acute episode of go ut, and gout prophylaxis (NSAIDs or colchicine) should be prescribed during the introduction of urate lowering therapy.