Treatment and prophylaxis of gout flare in the clinic: an office-based approach to gout management.

Gout is an often-overlooked and undertreated inflammatory arthritis that is most frequently managed in the primary care office. Its initial clinical presentation may include acute-onset pain that is most typically associated with the big toe (podagra) or knee. Most patients with gout can be successfully treated from the primary care physician's office with little or no need for referral to a rheumatology practice. Prompt recognition, diagnosis, and management can greatly improve the lives of patients with gout. Patient education is important; addressing modifiable risk factors promptly after initial presentation can arrest the development of serious debilitating effects and improve, or occasionally replace, pharmacologic intervention. This article will discuss the epidemiology, pathophysiology, and diagnosis of gout, as well as management of the acute flare and management of chronic gout with urate-lowering therapy, including prophylaxis.