Goals of therapy are to prevent acute attacks and to avoid complications.
Initial management of the patient should focus on:
(1) making lifestyle and dietary changes to reduce risk
(2) managing any comorbid conditions that may be contributory
(3) stopping or avoiding non-essential drugs that may contribute to hyperuricemia
Indications for urate lowering drug therapy:
(1) one or more tophi (clinical and/or on imaging studies)
(2) >= 2 acute attacks of the gout per year (frequent)
(3) chronic kidney disease Stage 2 or higher
(4) history of uric acid urolithiasis
Treatment target based on serum uric acid concentration:
(1) If asymptomatic, then serum urate should be < 6 mg/dL.
(2) If symptomatic, then may need to reduce serum urate to < 5 mg/dL.
The patient may also be started on prophylaxis to prevent acute attacks, especially if there is a history of frequent acute attacks.
