🩺 General MedicineRheumatologyStudentInternResident

Gout

Also known as: gouty arthritis · hyperuricaemia

A crystal arthritis from monosodium-urate deposition — an acutely hot, swollen, exquisitely tender joint (classically the first big-toe joint). Recurrent attacks and tophi follow chronic hyperuricaemia.

Source · Reviewed 2026-08-15 · v1.0— AI-assisted draft — verify against the cited guideline before clinical use.

⚕️ Education only — not medical advice. Verify against the latest official guideline and your local protocol; confirm every drug dose against the cited source before clinical use.

Who gets it

Men and post-menopausal women; risk with high purine intake/alcohol, obesity, diuretics, chronic kidney disease and metabolic syndrome.

Red flags — escalate / refer

A hot swollen joint may be SEPTIC ARTHRITIS — if febrile or unwell, aspirate and treat as septic until proven otherwise.

Work-up / diagnosis

1Clinical, ideally confirmed by joint aspiration (negatively birefringent urate crystals — which also excludes infection).
2Serum urate (may be normal during an acute attack — recheck later); assess renal function and cardiovascular risk.

Management — overview

Acute attack — an NSAID, colchicine, or a corticosteroid (choose by comorbidity); rest the joint.
Urate-lowering therapy (for recurrent attacks, tophi, stones or CKD) — start allopurinol, titrated to a urate target, once the acute attack settles, with colchicine/NSAID cover during initiation.
Lifestyle (alcohol, weight, review diuretics); do NOT stop established urate-lowering therapy during an attack.

In-depthFull dosing & advanced protocol

Drug dosing

Acute: NSAID or colchicine or corticosteroid

Terminate the acute flare

Adult dose: Per protocol and comorbidity
Route: Oral / intra-articular

ICMRStandard Treatment Workflows (STWs), India — Dept. of Health Research & ICMR (2022+) ↗

Allopurinol (urate-lowering)

Prevent recurrence — treat to target urate

Adult dose: Start low, titrate to target with flare prophylaxis cover
Route: Oral

Caution: Start after the flare settles; dose-adjust in renal impairment.

WHOWHO Model List of Essential Medicines (electronic EML) (2025 (24th)) ↗

Exclude sepsis; treat urate to target

Always consider septic arthritis in a single hot joint.
Urate can be normal during an acute attack — don't be falsely reassured.
Start urate-lowering after a flare settles, but never stop it if already established; aim for a target urate.

ICMRStandard Treatment Workflows (STWs), India — Dept. of Health Research & ICMR (2022+) ↗

References

Guidelines change. If something here is out of date, tell us — we keep these current.

🚩 Report outdated / suggest update

More protocols

HypertensionPersistently raised arterial pressure (≥140/90 mmHg) — a leading, modifiable cause of stroke, heart attack, heart failure and kidney disease.DengueAn Aedes-borne viral febrile illness. Most cases self-limit, but plasma leakage can cause severe dengue — early recognition of warning signs and careful fluid therapy save lives.MalariaA mosquito-borne protozoal (Plasmodium) febrile illness. In India P. vivax and P. falciparum predominate; prompt diagnosis and species-specific treatment prevent severe disease.

Loading…

👤 Who gets it

🚩 Red flags — escalate / refer

🔎 Work-up / diagnosis

🧭 Management — overview

💊 Drug dosing

Acute: NSAID or colchicine or corticosteroid

Allopurinol (urate-lowering)

📈 Exclude sepsis; treat urate to target

📚 References

More protocols

👤 Who gets it

🚩 Red flags — escalate / refer

🔎 Work-up / diagnosis

🧭 Management — overview

💊 Drug dosing

Acute: NSAID or colchicine or corticosteroid

Allopurinol (urate-lowering)

📈 Exclude sepsis; treat urate to target

📚 References

More protocols

Who gets it

Red flags — escalate / refer

Work-up / diagnosis

Management — overview

Drug dosing

Exclude sepsis; treat urate to target

References

Who gets it

Red flags — escalate / refer

Work-up / diagnosis

Management — overview

Drug dosing

Exclude sepsis; treat urate to target

References