JAMA: 2012-11-28, Vol. 308, No. 20, Author in the Room™ Audio Interview

Interview with Robert H. Shmerling, MD, author of Management of Gout: A 57-Year-Old Man With a History of Podagra, Hyperuricemia, and Mild Renal Insufficiency. Summary Points: Risk factor modification: alcohol intake, excess weight, diet, medications (although overall impact on gout uncertain). Acute gout can be treated with NSAIDs, colchicine, corticosteroids, or a combination of these. Urate-lowering treatment to prevent attacks and tophi is appropriate for certain patients with gout. (In my opinion, allopurinol is the best initial choice to suppress uric acid.) Urate-lowering treatment should suppress uric acid to 6.0 mg/dL or less; allopurinol should start no higher than 100 mg/d but titrate up based on uric acid levels; it is common to require more than 300 mg/d. Concomitant prophylaxis (eg, low-dose colchicine, 0.6 mg/d) is appropriate for 6-9 months or longer. Take home message: We now have new therapies and guidelines for the treatment of gout. Appropriate use of therapeutics for gout—both new and old—will provide optimal outcomes for the increasing number of patients with this common disease.