Gout is a type of inflammatory arthritis that causes pain and swelling in your joints, usually as flares that last for a week or two, and then resolve. Gout flares often begin in your big toe or a lower limb. Gout happens when high levels of serum urate build up in your body, which can then form needle-shaped crystals in and around the joint.
This leads to inflammation and arthritis of the joint. When the body makes too much urate, or removes too little, urate levels build up in the body. However, many people with high levels of serum urate will not develop gout.
Areas of the body that can be affected by gout include:
- Bursae, cushion-like sacs between bones and other soft tissues.
- Tendon sheaths, membranes that surround tendons.
- Kidneys, because the high uric acid levels can lead to stones and sometimes kidney damage.
Gout is a disease that can move through several stages:
- Hyperuricemia, when you have elevated levels of urate in your blood and crystals are forming in the joint, but you do not have symptoms.
- Gout flares, when you have an attack of intense pain and swelling in your joints.
- Interval or intercritical gout, which is the time between gout attacks when you do not have any symptoms.
- Tophi, a late stage of gout when crystals build up in the skin or other areas of the body. Depending on their location, tophi can permanently damage your joints and other internal organs such as the kidneys. Proper treatment can prevent the development of tophi.
With early diagnosis, treatment, and lifestyle changes, gout is one of the most controllable forms of arthritis.
Who Gets Gout?
Often, gout first attacks your big toe. It can also attack ankles, heels, knees, wrists, fingers, and elbows. At first, gout attacks usually get better in days. Eventually, attacks last longer and happen more often. Many people develop gout. It is more common in men than in women. Gout usually develops in middle age. Women usually do not develop gout before menopause, which is why women tend to develop the disease at a later age than men. Rarely, younger people develop the disease; however, if they do, the disease tends to be more severe.
You are more likely to get gout if you
- Are a man
- Have family member with gout
- Are overweight
- Drink alcohol
- Eat too many foods rich in purines
Gout can be hard to diagnose. Your doctor may take a sample of fluid from an inflamed joint to look for crystals. You can treat gout with medicines.
Pseudogout has similar symptoms and is sometimes confused with gout. However, it is caused by calcium phosphate, not uric acid.
What is Gout?
Gout is a common form of inflammatory arthritis that is very painful. It usually affects one joint at a time (often the big toe joint). There are times when symptoms get worse, known as flares, and times when there are no symptoms, known as remission. Repeated bouts of gout can lead to gouty arthritis, a worsening form of arthritis.
There is no cure for gout, but you can effectively treat and manage the condition with medication and self-management strategies.
Gout is a type of arthritis, which is a group of related disorders caused by episodes of abnormal inflammation in the joints. People with gout have high levels of a substance called urate in the blood (hyperuricemia). Gout develops when hyperuricemia leads to the formation of urate crystals in joints, triggering an inflammatory response from the immune system.
In people with gout, the first episode of inflammation (called a flare) usually affects the big toe or other joints in the foot or ankle. If urate levels remain high, flares can recur, affecting additional joints throughout the body. The time between flares varies among affected individuals; however, most people who experience multiple flares have their second one within a year of their first.
Flares usually begin at night and can last several days. It is unclear what causes a flare to stop; the body likely turns off the inflammation response after a certain period of time. During a flare, individuals can experience throbbing or burning pain, swelling, warmth, redness, and difficulty moving the affected joint. Fevers may occur, after which the skin over the affected joint can begin to peel. Without treatment, people with gout can experience frequent flares and joint pain and damage, which can limit mobility and decrease quality of life.
In about 15 percent of people with gout, urate accumulates in the kidneys and forms kidney stones. As the condition worsens, urate crystals can also be deposited under the skin or in other soft tissue, forming a nodule called a tophus (plural: tophi). These tophi often form in the hands, elbows, or feet. Tophi do not typically cause pain, but they can become inflamed, infected, or ooze fluid. Depending on their location, tophi can interfere with movements such as walking or gripping objects.
Many people with gout also have other health conditions. Most affected individuals have high blood pressure (hypertension), chronic kidney disease, or obesity. Some also have diabetes, heart disease, or a history of stroke. It is unclear whether gout is the cause of a person’s increased risk for these conditions, or whether the conditions cause the development of gout, or whether both of these situations occur to influence disease.
What Are the Signs and Symptoms of Gout?
Gout flares start suddenly and can last days or weeks. These flares are followed by long periods of remission—weeks, months, or years—without symptoms before another flare begins. Gout usually occurs in only one joint at a time. It is often found in the big toe. Along with the big toe, joints that are commonly affected are the lesser toe joints, the ankle, and the knee.
Gout is a type of inflammatory arthritis caused by the buildup of uric acid crystals in the joints. It primarily affects the joint at the base of the big toe but can occur in other joints as well. The signs and symptoms of gout can be sudden and severe, and they typically include:
- Intense Joint Pain: Gout pain is often described as excruciating, with a sudden onset. It usually affects one joint, most commonly the big toe, but it can also involve the ankles, knees, elbows, wrists, or fingers.
- Swelling: The affected joint becomes swollen, red, and tender to the touch.
- Warmth: The affected area can feel warm or hot to the touch.
- Lingering discomfort: This residual discomfort can persist for a period ranging from a few days to several weeks. Subsequent gout attacks are often characterized by longer durations of discomfort and a higher likelihood of affecting multiple joints.
- Limited Range of Motion: Gout can restrict the affected joint’s movement due to pain and swelling.
- Flare-Ups: Gout symptoms can come and go in episodes or “flare-ups.” These episodes can last for several days and then subside, with some people experiencing periods of remission.
- Inflammation and Redness: The affected joint or joints typically exhibit signs of swelling, tenderness, warmth, and redness, which are characteristic indicators of the condition.
- Sudden Onset: Gout attacks often strike suddenly, frequently at night, and can be triggered by certain foods, alcohol, or stress.
- Tophi: Over time, if gout is not properly managed, uric acid crystals can form lumps under the skin, known as tophi. Tophi are usually painless but can cause joint deformity and erosion.
What Cause Gout?
Gout is primarily caused by a condition known as hyperuricemia, which is characterized by elevated levels of uric acid in the bloodstream. Uric acid is a natural waste product resulting from the breakdown of purines, which are compounds found in the body and certain foods. When uric acid accumulates in the body at higher levels than it can effectively process and excrete, it can lead to the formation of uric acid crystals, known as monosodium urate, in the joints, bodily fluids, and tissues. These crystals trigger an inflammatory response, causing gouty arthritis, a painful and often recurrent condition.
Several factors contribute to the development of hyperuricemia and, subsequently, gout:
- Genetics: Genetic factors can predispose some individuals to higher uric acid levels or impaired urate excretion. Specific genetic variations, such as those in the SLC2A9 and ABCG2 genes, can increase the risk of hyperuricemia and gout.
- Diet: The consumption of foods and beverages rich in purines, such as red meat, organ meats, seafood, certain vegetables (e.g., asparagus, spinach, and mushrooms), and alcoholic beverages (particularly beer), can lead to elevated uric acid levels. When purines are metabolized, uric acid is produced, contributing to hyperuricemia.
- Alcohol: Alcohol consumption, particularly beer and spirits, can raise uric acid levels in the body. Beer, in particular, contains a high concentration of purines and can stimulate uric acid production while reducing its excretion.
- Dehydration: Inadequate fluid intake can lead to dehydration, which reduces the body’s ability to effectively excrete uric acid, increasing its concentration in the bloodstream.
- Obesity: Excess body weight is associated with higher uric acid levels. Adipose tissue can promote uric acid production and impede its excretion.
- Certain Medications: Some medications, such as diuretics (often prescribed for hypertension or heart failure), can elevate uric acid levels by reducing its excretion through the kidneys.
- Medical Conditions: Underlying medical conditions like kidney disease, high blood pressure, metabolic syndrome, and diabetes can affect uric acid metabolism and lead to hyperuricemia.
- Genetic Predisposition: Family history and genetics can play a role in an individual’s susceptibility to gout. If gout is prevalent among family members, the risk of developing the condition may be higher.
Gout results from a condition known as hyperuricemia, characterized by an excess of uric acid in the body. Uric acid is produced during the breakdown of purines, compounds found in both the body and the foods we consume. When there is an excessive accumulation of uric acid, uric acid crystals, or monosodium urate, can accumulate in joints, bodily fluids, and tissues. It’s important to note that hyperuricemia does not invariably lead to gout, and the absence of gout symptoms in individuals with hyperuricemia typically does not necessitate treatment.
Gout is influenced by a complex interplay of genetic and environmental factors. While some factors have been substantiated through research, others remain unidentified. The primary risk factor for developing gout is hyperuricemia, with approximately one-quarter of individuals with hyperuricemia progressing to gout. The reasons why certain individuals with hyperuricemia do not develop gout remain unclear.
Large-scale studies have identified numerous genes that contribute to the development of gout. Multiple genetic variations, each with a modest effect, appear to combine and heighten the risk of this condition. Most of the identified genes are involved in the regulation of urate, a byproduct of normal biochemical processes. Many of these genes participate in either releasing urate into the urine when levels are elevated or reabsorbing it into the bloodstream when the body requires more. The roles of some of these genes are still not fully understood. Among all the genes studied, two genes, SLC2A9 and ABCG2, appear to exert the most significant influence on urate levels.
The SLC2A9 gene encodes a protein primarily found in the kidneys, where it plays a crucial role in managing urate levels. This protein facilitates the reabsorption of urate into the bloodstream and its release into the urine. Genetic variations in the SLC2A9 gene that result in hyperuricemia increase urate reabsorption into the bloodstream while reducing its release into the urine.
The ABCG2 gene encodes a protein that aids in the removal of urate from the body by releasing it into the gut. Genetic variations in the ABCG2 gene that lead to hyperuricemia decrease the protein’s ability to release urate into the gut.
Non-genetic factors are also believed to contribute to gout, often by triggering gout flares. These factors frequently elevate urate levels in the body. The consumption of foods and beverages rich in purines, such as red meat, seafood, dried beans, alcohol, and sugary drinks, can lead to elevated urate levels. As purines break down, urate is generated, potentially causing hyperuricemia and gout in susceptible individuals. Gout risk also rises with age, especially among women after menopause. Following menopause, the decline in estrogen, a hormone involved in urate removal from the body, leads to elevated urate levels and an increased risk of developing gout in older women.
What Increases Your Chances for Gout?
The following make it more likely that you will develop hyperuricemia, which causes gout:
- Being male
- Being obese
- Having certain health conditions, including:
- Congestive heart failure
- Hypertension (high blood pressure)
- Insulin resistance
- Metabolic syndrome
- Poor kidney function
- Using certain medications, such as diuretics (water pills).
- Drinking alcohol. The risk of gout is greater as alcohol intake goes up.
- Eating or drinking food and drinks high in fructose (a type of sugar).
- Having a diet high in purines, which the body breaks down into uric acid. Purine-rich foods include red meat, organ meat, and some kinds of seafood, such as anchovies, sardines, mussels, scallops, trout, and tuna.
How is Gout Diagnosed?
Diagnosing gout involves a combination of clinical evaluation, medical history, and diagnostic tests. To confirm a gout diagnosis, healthcare professionals typically follow these steps:
- Medical History: The healthcare provider will inquire about your medical history, including any past episodes of joint pain, family history of gout, dietary habits, and lifestyle factors. Providing information about your diet, alcohol consumption, and medication use is important.
- Physical Examination: The healthcare provider will conduct a physical examination to assess the affected joint(s). They will look for signs of inflammation, such as swelling, redness, and tenderness. The joint most commonly affected by gout is the base of the big toe, but gout can also occur in other joints.
- Symptoms: Gout is known for its sudden onset, intense pain, and inflammation. If you’re experiencing these typical symptoms, it raises suspicion of gout.
- Blood Tests: Blood tests are often performed to measure the levels of uric acid in the bloodstream. It’s important to note that elevated uric acid levels, while a common characteristic of gout, are not definitive proof of the condition. Some people with high uric acid levels do not develop gout, and others with gout may have normal uric acid levels during an attack.
- Joint Aspiration (Arthrocentesis): This is a crucial diagnostic test for gout. It involves using a thin needle to withdraw a sample of fluid from the affected joint. The fluid is then examined under a microscope for the presence of uric acid crystals. The identification of uric acid crystals in the joint fluid is considered the gold standard for confirming a gout diagnosis.
- Imaging Studies: In some cases, imaging tests like X-rays or ultrasound may be used to assess the affected joint(s) and check for any joint damage or tophi (collections of urate crystals). These tests may also help rule out other conditions that can mimic gout, such as joint infections or other types of arthritis.
Gout can be challenging to diagnose based solely on symptoms or blood tests, as other conditions can produce similar signs and elevated uric acid levels. The definitive confirmation of gout typically relies on the identification of uric acid crystals in the joint fluid obtained through joint aspiration.
A medical doctor diagnoses gout by assessing your symptoms and the results of your physical examination, X-rays, and lab tests. Gout can only be diagnosed during a flare when a joint is hot, swollen, and painful and when a lab test finds uric acid crystals in the affected joint.
Gout is a common condition, but it occurs more frequently in some populations than others. For example, gout occurs in 1 percent of people with Asian ancestry, 3 to 4 percent of people with European ancestry, and 6 to 8 percent of Indigenous (native) Taiwanese peoples and Māori from New Zealand.
How is Gout Treated?
Gout can be effectively treated and managed with medical treatment and self-management strategies. Your health care provider may recommend a medical treatment plan to
- Manage the pain of a flare. Treatment for flares consists of nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen, steroids, and the anti-inflammatory drug colchicine.
- Prevent future flares. Making changes to your diet and lifestyle, such as losing weight, limiting alcohol, eating less purine-rich food (like red meat or organ meat), may help prevent future attacks. Changing or stopping medications associated with hyperuricemia (like diuretics) may also help.
- Prevent tophi and kidney stones from forming as a result of chronic high levels of uric acid. Tophi are hard, uric acid deposits under the skin. For people with frequent acute flares or chronic gout, doctors may recommend preventive therapy to lower uric acid levels in the blood using drugs like allopurinol, febuxostat, and pegloticase.
In addition to medical treatment, you can manage your gout with self-management strategies. Self-management is what you do day to day to manage your condition and stay healthy, like making healthy lifestyle choices. The self-management strategies described below are proven to reduce pain and disability, so you can pursue the activities important to you.
Gout is a painful and chronic condition, but it can be effectively managed with the right treatment and lifestyle changes. The goals of gout treatment are to alleviate pain during acute attacks, prevent future attacks, and reduce the risk of long-term complications, such as joint damage and the formation of tophi (urate crystal deposits).
Here are some common approaches to treating gout:
- Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): These drugs, like indomethacin or ibuprofen, help relieve pain and reduce inflammation during acute gout attacks.
- Colchicine: Colchicine is another anti-inflammatory medication that can be used to alleviate gout symptoms during an attack.
- Corticosteroids: In some cases, corticosteroid medications, either oral or injected into the affected joint, may be prescribed to reduce inflammation and pain.
- Medications to Lower Uric Acid Levels:
- Xanthine Oxidase Inhibitors: Drugs like allopurinol and febuxostat help lower uric acid levels by reducing its production.
- Uricosurics: Medications like probenecid increase the excretion of uric acid through the kidneys.
- Uricase Enzyme Replacement: Pegloticase is an enzyme replacement therapy that breaks down uric acid into a soluble form for easier excretion.
- Interleukin-1 Inhibitors: Some biologic medications, such as anakinra, can be used in refractory or severe cases of gout.
- Lifestyle and Dietary Changes:
- Diet: Reducing the intake of high-purine foods, such as red meat, organ meats, seafood, and alcohol, can help lower uric acid levels. Increasing the consumption of low-purine foods, like vegetables and whole grains, is also beneficial.
- Hydration: Staying well-hydrated can help the body excrete uric acid more effectively. Drinking plenty of water is important.
- Weight Management: Maintaining a healthy weight or losing excess weight can reduce the risk of gout attacks.
- Alcohol: Limiting or avoiding alcohol, especially beer and spirits, is recommended.
- Exercise: Regular physical activity can help improve joint function and overall health.
- Prevention: To prevent future gout attacks, medication to lower uric acid levels may be prescribed on a long-term basis. This is especially important for individuals with recurrent or severe gout.
Medications to Treat Gout Attacks
Medications are commonly used to treat acute gout attacks. The goal of these medications is to reduce pain and inflammation, as well as to expedite the recovery from an acute gout flare. Commonly prescribed medications for gout attacks include:
- Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): These drugs, available both over-the-counter and by prescription, are often the first-line treatment for gout attacks. NSAIDs help reduce pain and inflammation. Examples include indomethacin, ibuprofen, and naproxen.
- Colchicine: Colchicine is an anti-inflammatory medication that can effectively relieve gout symptoms during an acute attack. It is usually used for gout attacks when NSAIDs are not well-tolerated or as a second-line treatment.
- Corticosteroids: In cases where NSAIDs or colchicine are not suitable or effective, corticosteroids may be prescribed. They can be administered orally or injected directly into the affected joint. Prednisone is a commonly used oral corticosteroid for gout.
- Intra-Articular Steroid Injection: In cases where one joint is severely affected, such as the big toe, a healthcare provider may inject corticosteroids directly into the joint for rapid relief.
How Can I Manage my Gout and Improve my Quality of Life?
Managing gout and improving your quality of life involves a combination of medical treatment, lifestyle modifications, and dietary changes. Here are some steps you can take to effectively manage gout:
- Consult a Healthcare Professional: The first step is to consult a healthcare provider, preferably a rheumatologist or a specialist in gout, for an accurate diagnosis and a tailored treatment plan.
- Medication Management:
- Take prescribed medications as directed, including anti-inflammatory drugs for acute attacks and medications to lower uric acid levels for long-term management.
- Don’t stop or change medications without consulting your healthcare provider.
- Lifestyle and Dietary Changes:
- Dietary Modifications: Adopt a gout-friendly diet by reducing the intake of high-purine foods, such as red meat, organ meats, seafood, and alcohol. Focus on consuming more low-purine foods, like vegetables and whole grains.
- Hydration: Stay well-hydrated by drinking plenty of water. Aim for at least 8-10 cups of water per day to help the body excrete uric acid effectively.
- Weight Management: Maintain a healthy weight through a balanced diet and regular exercise. Weight loss, if necessary, can reduce the risk of gout attacks.
- Alcohol Reduction: Limit or avoid alcohol consumption, particularly beer and spirits, as they can contribute to gout.
- Exercise: Engage in regular physical activity, including low-impact exercises like swimming or walking, which can improve joint function and overall health.
- Monitoring: Regularly monitor your uric acid levels through blood tests and assess your gout symptoms to gauge treatment effectiveness.
- Pain Management: Use over-the-counter pain relievers as recommended by your healthcare provider during acute gout attacks. Avoid aspirin, as it may exacerbate gout.
- Joint Care: Treat your joints with care, especially during and after gout attacks. Rest, elevate, and ice the affected area to alleviate pain and inflammation.
- Compliance: Adhere to your prescribed treatment plan and maintain open communication with your healthcare provider about any concerns or changes in your condition.
- Lifestyle Adaptations: Make necessary adaptations to accommodate your condition. Consider footwear with ample room for comfort and support.
- Educate Yourself: Learn more about gout, its triggers, and effective management strategies. Understanding the condition can help you make informed decisions about your treatment and lifestyle choices.
- Regular Check-Ups: Continue to schedule regular check-ups with your healthcare provider to assess your gout management and make any necessary adjustments to your treatment plan.
Effective gout management can help reduce the frequency and severity of gout attacks, alleviate pain and inflammation, and improve your overall quality of life.
CDC’s Arthritis Program recommends five self-management strategies for managing arthritis and its symptoms. These can help with gout as well.
- Learn self-management skills. Join a self-management education class, which helps people with arthritis and other chronic conditions—including gout—understand how arthritis affects their lives and increase their confidence in controlling their symptoms and living well. Learn more about the CDC-recommended self-management education programs.
- Get physically active. Experts recommend that adults engage in 150 minutes per week of at least moderate physical activity. Every minute of activity counts, and any activity is better than none. Moderate, low impact activities recommended include walking, swimming, or biking. Regular physical activity can also reduce the risk of developing other chronic diseases such as heart disease, stroke, and diabetes. Learn more about physical activity for arthritis.
- Go to effective physical activity programs. For people who worry that physical activity may make arthritis worse or are unsure how to exercise safely, participation in physical activity programs can help reduce pain and disability related to arthritis and improve mood and the ability to move. Classes take place at local Ys, parks, and community centers. These classes can help people with arthritis feel better. Learn more about CDC-recommended physical activity programs.
- Talk to your doctor. You can play an active role in controlling your arthritis by attending regular appointments with your health care provider and following your recommended treatment plan. This is especially important if you also have other chronic conditions, like diabetes or heart disease.
- Lose weight. For people who are overweight or obese, losing weight reduces pressure on joints, particularly weight bearing joints like the hips and knees. Reaching or maintaining a healthy weight can relieve pain, improve function, and slow the progression of arthritis.
- Protect your joints. Joint injuries can cause or worsen arthritis. Choose activities that are easy on the joints like walking, bicycling, and swimming. These low-impact activities have a low risk of injury and do not twist or put too much stress on the joints. Learn more about how to exercise safely with arthritis.
Complications of Gout
Gout is a painful condition caused by the buildup of uric acid crystals in the joints. If left untreated or inadequately managed, it can lead to various complications. Common complications of gout include:
- Joint Damage: Repeated gout attacks can cause joint damage and erosion. Over time, uric acid crystals can accumulate in the affected joint, leading to cartilage degradation, joint deformities, and limited joint function.
- Tophi: Tophi are lumps or nodules that form under the skin when uric acid crystals accumulate in the soft tissues. Tophi can cause pain, discomfort, and disfigurement. They are often seen in the fingers, hands, elbows, and other areas.
- Kidney Stones: High levels of uric acid in the bloodstream can lead to the formation of uric acid kidney stones. These stones can cause kidney pain, urinary tract issues, and complications if not addressed.
- Chronic Kidney Disease: Gout can contribute to chronic kidney disease, particularly if it’s inadequately managed. High uric acid levels may lead to kidney damage and reduced kidney function.
- Cardiovascular Issues: Some studies suggest an increased risk of cardiovascular disease in individuals with gout. The chronic inflammation associated with gout may contribute to heart-related complications.
- Hypertension: Gout is often linked to high blood pressure (hypertension), and the two conditions can exacerbate each other. Hypertension is a risk factor for heart disease and stroke.
- Obesity and Metabolic Syndrome: Gout and obesity are interrelated, and the presence of metabolic syndrome (a cluster of risk factors that increase the risk of heart disease and type 2 diabetes) can complicate gout management.
- Physical Disability: Severe and uncontrolled gout can lead to physical disability due to joint damage and limited mobility.
- Depression and Decreased Quality of Life: Chronic pain, recurrent attacks, and complications of gout can lead to emotional and psychological issues, including depression, anxiety, and a reduced quality of life.
- Secondary Medical Conditions: The medications used to treat gout, such as nonsteroidal anti-inflammatory drugs (NSAIDs), can have side effects and contribute to other medical conditions if not used carefully.
Medications to Prevent Gout Complications
Medications to prevent gout complications are typically prescribed for long-term management of the condition, with the aim of reducing uric acid levels in the bloodstream and preventing the recurrence of gout attacks and related complications. These medications are known as urate-lowering therapies (ULTs). Common medications used to prevent gout complications include:
- Xanthine Oxidase Inhibitors:
- Allopurinol: Allopurinol is one of the most commonly prescribed ULTs. It works by inhibiting the enzyme xanthine oxidase, which plays a key role in the production of uric acid. Allopurinol helps lower uric acid levels over time.
- Febuxostat: Febuxostat is another xanthine oxidase inhibitor that reduces uric acid production. It may be prescribed when allopurinol is not well-tolerated or ineffective.
- Uricosuric Agents:
- Probenecid: Probenecid is a medication that increases the excretion of uric acid through the kidneys. It is typically used in cases where the kidneys are functioning normally. Probenecid is often prescribed when xanthine oxidase inhibitors are not effective or contraindicated.
- Uricase Enzyme Replacement:
- Pegloticase: Pegloticase is an enzyme replacement therapy that converts uric acid into a more soluble form that can be more easily excreted from the body. It is usually considered for individuals with severe gout who have not responded to other treatments.
- Interleukin-1 Inhibitors:
- Anakinra: Anakinra is a biologic medication used in refractory or severe cases of gout. It works by targeting the interleukin-1 pathway, which is involved in the inflammatory response associated with gout.
- Combination Therapy: In some cases, healthcare providers may recommend combination therapy using two or more of the above medications to achieve better control of uric acid levels.
It’s important to note that urate-lowering therapies (ULTs) should be used under the supervision of a healthcare provider. Medications should be tailored to the individual based on factors such as the severity of gout, any contraindications, and the presence of comorbid conditions.