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Contentious Issues in Gout Management: The Story so Far


Open Access Rheumatol. 2021 May 12;13:111-122. doi: 10.2147/OARRR.S282631.eCollection 2021.

Mohamed Talaat 1Kyle Park 1Naomi Schlesinger 2

Author Information

1 Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ, USA.

2 Division of Rheumatology, Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, 08903-0019, USA.


Gout is the most common inflammatory arthritis worldwide. Although gout has been known for antiquity, many challenges still exist in gout management. It is vital to view gout as a chronic disease and not just treat the acute flare. There is a perception of gout as an acute disease requiring treatment only for acute flares. However, to combat the disease, chronic urate-lowering therapy, reducing the serum urate levels to below the saturation threshold of 6.8 mg/dL, and chronic anti-inflammatory prophylaxis, especially during urate-lowering therapy initiation, are needed. In this manuscript, we discuss some of the contentious issues in gout management. These include the timing of urate-lowering therapy initiation, which urate-lowering therapy to chose, should comorbidities influence our treatment, using genetic determinants, and patient perspectives to drive treatment and differences between gout treatment the American College of Physicians and Rheumatology guidelines for gout management: driving care.