Clinical Crossroads Section Editor: Edward H. Livingston, MD, Deputy Editor, JAMA.
Author Affiliations: Dr Shmerling is Clinical Chief, Division of Rheumatology and Program Director, Rheumatology Fellowship, Beth Israel Deaconess Medical Center, Associate Professor of Medicine, Harvard Medical School, and Senior Editor, Harvard Health Publications, Boston, Massachusetts.
Gout is an ancient disease. Despite significant advances in the understanding of its risk factors, etiology, pathogenesis, prevention, and treatment, millions of people with gout experience repeated attacks of acute arthritis and other complications. The incidence of gout is increasing, most likely reflecting increasing rates of obesity and other lifestyle factors, including diet. Comorbid conditions that often accompany gout, including chronic kidney disease and diabetes mellitus, present challenges for the management of gout. Using the case of Mr R, a 57-year-old man with a history of podagra, hyperuricemia, and mild renal insufficiency, the diagnosis and treatment of gout are discussed. For those with moderate to severe gout, urate-lowering treatment can eliminate acute attacks of arthritis and prevent complications. In the near future, it is likely that new risk factors for gout will be identified and new ways of preventing and managing this common disease will become available.
Shmerling RH. Management of GoutA 57-Year-Old Man With a History of Podagra, Hyperuricemia, and Mild Renal Insufficiency. JAMA. 2012;308(20):2133-2141. doi:10.1001/jama.2012.65028