title: The unwelcome visitor.
abstract: Gout is a chronic, progressive inflammatory disease with intermittent arthritic flares, which should not be regarded as a minor inconvenience or nuisance. It can be effectively controlled when the patient's serum urate level is reduced to less than 360 μmol/l (6 mg/dL) by consistent use of urate-lowering pharmacotherapy. Colchicine prophylaxis for gouty flares during titration of urate-lowering therapy has been underused. Holistic long-term management of gout must encompass patient education, evidence-based dietary advice, screening and aggressive treatment of comorbidities such as hypertension, diabetes mellitus, dyslipidaemia and renal impairment. Acute therapies for recurrent attacks with non-steroidal anti-inflammatory drugs, colchicine and/or corticosteroids should be used judiciously, especially in the elderly, due to the risk of toxicities. With appreciation of the underlying pathogenesis and artful use of the limited drug options, control of gout can be effectively achieved, bringing tremendous satisfaction to the patient and doctor.
authors.affiliation: University Medicine Cluster, Division of Rheumatology, National University Health System, Singapore. gim_gee_teng@nuhs.edu.sg
authors.forename: Gim Gee
authors.initials: GG
authors.lastname: Teng
authors.forename: Chung Yan
authors.initials: CY
authors.lastname: Tong
authors.forename: Choon How
authors.initials: CH
authors.lastname: How
authors.forename: Lay Hoon
authors.initials: LH
authors.lastname: Goh
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D000328:Adult; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use*; D002908:Chronic Disease; D003078:Colchicine / Q000627:therapeutic use*; D006073:Gout / Q000175:diagnosis* / Q000178:diet therapy / Q000188:drug therapy; D006801:Humans; D008297:Male; D014527:Uric Acid / Q000097:blood
chemical_list: D000305:Adrenal Cortex Hormones; D000894:Anti-Inflammatory Agents, Non-Steroidal; D014527:Uric Acid; D003078:Colchicine