Prevention of recurrent gout: Lifestyle modification and other strategies for risk reduction
- Michael A Becker, MD
Michael A Becker, MD
- Section Editor — Crystal Diseases
- Professor Emeritus of Medicine
- University of Chicago Pritzker School of Medicine
Gout is monosodium urate crystal deposition disease; in the absence of urate saturation of extracellular fluids (reflected by hyperuricemia: serum urate levels >6.8 mg/dL [405 micromol/L]) and of urate crystal deposition and body responses to crystal deposition, the symptoms and signs of gout do not occur. In addition, there is no evidence that serum urate reduction to levels that remain above the limit of solubility carries with it clinical benefits equivalent to those achievable at sub-saturating levels. Thus, gout can be regarded as a “threshold” disease, in which the long-term goal of therapy to prevent recurrent gout and reverse prior signs of the disease is to achieve and maintain sub-saturating serum urate concentrations.
Management for the prevention of recurrent episodes of acute gout and damage to joints and other tissues from urate crystal deposition includes drug therapy as well as lifestyle modification and other strategies for risk reduction. Long-term success in maintaining sub-saturating urate levels is attended by clinical benefits that include cessation of acute gout flares, resolution of tophi, and improvement in patient physical function and health-related quality of life. However, resolution of the urate crystal burden may require many months to several years to attain, even after sub-saturating urate levels are achieved either by lifestyle modifications (risk reduction) and/or with oral urate-lowering agents. During this period of crystal dissolution, a risk for acute flare remains and is the primary basis for gout flare prophylaxis with antiinflammatory agents.
The prevention of recurrent gout and of disease progression by use of nonpharmacologic lifestyle modifications for urate lowering and by risk reduction involving drug choices for management of comorbid diseases (eg, hypertension) will be reviewed here. Treatment with urate-lowering drugs, the role of surgery for treating tophi, the clinical manifestations and diagnosis of gout, the prophylaxis and treatment of episodes of acute gouty arthritis, and issues related to asymptomatic hyperuricemia are discussed separately. (See "Prevention of recurrent gout: Pharmacologic urate-lowering therapy and treatment of tophi" and "Clinical manifestations and diagnosis of gout" and "Treatment of acute gout" and "Asymptomatic hyperuricemia".)
Upon resolution of an acute gouty attack, the patient is said to have entered an intercritical (between attacks) period (see "Clinical manifestations and diagnosis of gout", section on 'Intercritical gout and recurrent gouty arthritis'); during this period, the following preventive issues should be addressed:
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