![]() ![]() 3 The heritability of the serum urate concentration may be as high as 60% 6 other risk factors for hyperuricemia and gout include male sex, older age, dietary and lifestyle factors, obesity, renal impairment, and the use of medications (e.g., diuretics) that increase urate concentrations. This condition, which is defined as a circulating uric acid level that exceeds the solubility threshold for monosodium urate (>6.8 mg per deciliter), is three to five times as common as gout. Hyperuricemia is a necessary but insufficient risk factor. ![]() Treatment for gout must be individualized to account for coexisting cardiometabolic and renal conditions, which are often overrepresented in this patient population.Īlthough potentially beneficial in the management of associated conditions, dietary and lifestyle modifications alone are seldom adequate interventions for lowering urate concentrations. When feasible, patients should keep medication on hand (the “pill-in-a-pocket” approach) to facilitate early antiinflammatory treatment of gout flares.Īllopurinol represents the first line of therapy to lower urate concentrations and should be administered according to a treat-to-target approach (initial low doses followed by gradual dose escalation) to establish and maintain serum urate concentrations below 6.0 mg per deciliter. The most trusted, influential source of new medical knowledge and clinical best practices in the world.Īlthough the presence of monosodium urate crystals in aspirates obtained from joints, bursa, or tophi remains the reference standard, a clinical diagnosis of gout can be made on the basis of the presence of suggestive clinical features. Information and tools for librarians about site license offerings. ![]() Valuable tools for building a rewarding career in health care. The authorized source of trusted medical research and education for the Chinese-language medical community. The most advanced way to teach, practice, and assess clinical reasoning skills. Information, resources, and support needed to approach rotations - and life as a resident. The most effective and engaging way for clinicians to learn, improve their practice, and prepare for board exams. NEW! Peer-reviewed journal featuring in-depth articles to accelerate the transformation of health care delivery.Ĭoncise summaries and expert physician commentary that busy clinicians need to enhance patient care. NEW! A digital journal for innovative original research and fresh, bold ideas in clinical trial design and clinical decision-making. ![]()
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