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Management of Gout:  A 57-Year-Old Man With a History of Podagra, Hyperuricemia, and Mild Renal Insufficiency

Robert H. Shmerling, MD, Discussant
JAMA. 2012;308(20):2133-2141. doi:10.1001/jama.2012.65028.
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Gout is an ancient disease. Despite significant advances in the understanding of its risk factors, etiology, pathogenesis, prevention, and treatment, millions of people with gout experience repeated attacks of acute arthritis and other complications. The incidence of gout is increasing, most likely reflecting increasing rates of obesity and other lifestyle factors, including diet. Comorbid conditions that often accompany gout, including chronic kidney disease and diabetes mellitus, present challenges for the management of gout. Using the case of Mr R, a 57-year-old man with a history of podagra, hyperuricemia, and mild renal insufficiency, the diagnosis and treatment of gout are discussed. For those with moderate to severe gout, urate-lowering treatment can eliminate acute attacks of arthritis and prevent complications. In the near future, it is likely that new risk factors for gout will be identified and new ways of preventing and managing this common disease will become available.

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Figure. Metabolic Pathways of Uric Acid, Its Role in the Pathogenesis of Gout, and Key Mediators of Monosodium Urate (MSU) Crystal–Induced Inflammation
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