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Gout Arthritis (Internal Medicine Management)

Acute attack and chronic urate-lowering therapy: contemporary EULAR/ACR algorithm

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

References (5)

This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Dahiliye (İç Hastalıkları) department. Book Appointment →

What is Gout Arthritis (Internal Medicine Management)?

Gout is a metabolic disease leading to recurrent acute arthritis attacks, tophus formation, and chronic destructive arthropathy in the setting of persistent hyperuricemia. Prevalence is 3-6% in men and 1-2% in women; rising due to obesity, alcohol, and modern dietary patterns.

Acute attacks are usually monoarticular, presenting with sudden severe pain, swelling, and erythema in the first metatarsophalangeal joint (podagra). Diagnosis: identification of MSU crystals (negatively birefringent needle-shaped) under polarized microscopy in synovial fluid is the gold standard.

EULAR 2016 and ACR 2020 guidelines recommend urate-lowering therapy in patients with two or more attacks per year, tophi, urate stones, or stage 2-5 CKD. First line: allopurinol (start at 100 mg/day, titrate up to 300-800 mg). Second line: febuxostat (40-80 mg/day).

Symptoms

Sudden severe joint pain (often nocturnal onset)
First MTP joint redness, swelling, warmth (podagra)
Severe pain (cannot tolerate even bedsheet contact)
Knee, ankle, elbow attacks (less common locations)
Tophi (in chronic disease - earlobe, olecranon, finger joints)
Low-grade fever and malaise

Risk Factors

Male gender and postmenopausal women
Hyperuricemia (>6.8 mg/dL)
Obesity, hypertension, metabolic syndrome
Alcohol (especially beer) and fructose-rich beverages
Diuretics (thiazide, loop) and low-dose aspirin
Chronic kidney disease and family history

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • Sudden onset acute mono/oligoarthritis
  • Joint redness, swelling, severe pain
  • Recurrent attacks (2+ per year)
  • Tophus and joint deformity
  • Renal stone history with urate stones
  • Persistent hyperuricemia (>9 mg/dL)

Treatment Methods

01
Acute attack: NSAID (naproxen, indomethacin) - first 24h
02
Colchicine (1.2 mg + 0.6 mg after 1h) - first 36h
03
Intra-articular/oral steroid (NSAID-contraindicated)
04
Urate-lowering: allopurinol (titrate to target <6 mg/dL)
05
Febuxostat (in severe renal impairment, allopurinol intolerance)
06
Diet: alcohol, organ meats, seafood restriction

Which Department to Visit?

You can visit our Dahiliye (İç Hastalıkları) department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

Learn About Dahiliye (İç Hastalıkları) Department

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.