Disease Description (Causes and Symptoms)
Disease name: Gout (Gout)
- Causes and pathophysiology: When uric acid is overproduced or its excretion decreases, uric acid accumulates in the blood and is deposited in the joints and soft tissues as protein-like (needle-shaped) monosodium urate crystals, causing inflammation. Repeated inflammation can lead to joint damage, gouty tophi, kidney stones, and decreased kidney function.
- Main symptoms: Acute, attack-like joint pain (especially in the first joint of the big toe), sudden joint swelling, redness, and warmth, and sensitivity even to touch due to severe pain. Fever and chills may occur, and if the condition becomes chronic, multiple joints may be affected and gouty tophi and urinary tract stones may develop.
- Diagnostic essentials: Confirmation of needle-shaped urate crystals with negative birefringence under a microscope after joint aspiration is diagnostic. Blood uric acid is an ancillary marker and may be normal during an acute attack. Imaging tests include DECT (to confirm urate deposition), while plain X-rays are used to assess chronic changes.
Treatment Methods
- Treatment of acute attacks
- Follow the initial-dose guidelines for nonsteroidal anti-inflammatory drugs (NSAIDs, e.g., ibuprofen and naproxen) or colchicine, or use systemic/intra-articular steroids (oral or injectable).
- During the acute phase, pain relief and inflammation control take priority; sufficient rest and cooling or immobilization of the joint are recommended.
- Urate-lowering therapy (maintenance therapy, ULT)
- Uric acid target: Generally, blood uric acid <6 mg/dL (with a target of <5 mg/dL if tophi are present).
- Medications:
- Xanthine oxidase inhibitor: allopurinol — first-line treatment; dose adjustment is required (considering kidney function).
- Febuxostat — caution is required in patients with a history of cardiovascular disease (related concerns were reported in clinical trials).
- Uricosuric agents (such as probenecid) — an option for patients with sufficient kidney function.
- Uricase preparations such as pegloticase — used for severe/refractory gout (intravenous administration; risk of immune reactions).
- Timing of initiation: Starting after the acute attack has subsided is recommended; however, recent recommendations also allow initiation during an attack with appropriate pain control/prevention (low-dose colchicine/NSAID) used concurrently. Because attacks may become more frequent during the first several months after initiation, preventive therapy is necessary.
- Treatment continuity: Long-term, lifelong continuation is recommended in cases of recurrent attacks or complications such as tophi or urinary tract stones.
- Lifestyle management
- Follow a low-purine diet, limit alcohol (especially beer), limit fructose-containing beverages (fruit juice and sugary drinks), lose weight, and consume sufficient fluids.
- Actively treat coexisting conditions such as hypertension, hyperlipidemia, and diabetes.
- Precautions and complications
- Risk of severe skin reactions related to allopurinol (allopurinol hypersensitivity, associated with HLA-B5801) — consider HLA-B5801 testing in high-risk ethnic groups (including some Asian groups, including Koreans).
- During the first several months of urate-lowering therapy, concurrent use of low-dose colchicine (e.g., for 3–6 months) or a low-dose NSAID is recommended to prevent acute attacks.
- Regular monitoring of kidney function, liver function, blood tests, and other parameters is necessary during treatment.
Checklist Before an Outpatient Visit (Including Items to Prepare and Example Questions)
Items to prepare/information to provide:
- A list of all medications currently being taken (including prescription drugs, OTC medicines, herbal medicines, and supplements) — particularly whether any uric acid-raising medications, such as diuretics, low-dose aspirin, or niacin, are being used.
- Previous diagnoses and test results (blood uric acid, kidney function tests, liver function tests, radiographs, DECT images, etc.) or related medical records.
- A symptom diary documenting when the pain occurs, its frequency and duration, triggering factors (alcohol consumption, meals, and trauma), and methods that relieve the symptoms.
- Information about allergies (especially medication allergies and previous drug-related rashes) and family history (gout and kidney stones).
- Lifestyle habits (amount of alcohol consumed, weight changes, and diet) and coexisting conditions (hypertension, diabetes, cardiovascular disease, etc.).
Examples of materials to show healthcare professionals during an outpatient visit:
- Recent blood test results (uric acid and creatinine), urinalysis results, or recently taken photographs of the joint.
Questions you can ask the doctor at the hospital (examples):
- "What is my current blood uric acid level, and what is the target level?"
- "How will the side effects of this medication be identified and monitored?"
Examples of General Questions to Ask the Doctor
- What are the major side effects and monitoring intervals for this medication (allopurinol/febuxostat/colchicine/NSAID)?
- In my case, when should urate-lowering therapy begin, and how long should it continue?
- How often should I undergo testing (uric acid and kidney function) to achieve the uric acid target?
- If an acute attack occurs, what emergency measures should I take?
- What specific points should I follow regarding diet, exercise, and weight management?
Examples of Disease-Specific Questions
- Should I undergo HLA-B*5801 genetic testing (especially if I am an Asian person of Korean-Chinese ancestry)?
- What medication (e.g., low-dose colchicine) should I take to prevent attacks during the first 3–6 months after starting urate-lowering therapy, and for how long?