Gout attacks commonly occur in the ankle and big toe joints, usually affecting men and postmenopausal women, who may also have associated metabolic conditions like diabetes, hypertension and high cholesterol. Diet and alcohol have direct impact on this arthritis.
The attacks typically reach a peak of excruciating pain in 6 hours from onset, but usually resolve in 5 days. As the disease worsens, attacks become more frequent, and last longer, to the point on constant inflammation and pain.
Xanthine Oxidase inhibitors (which reduce uric acid production) and Uricosuric agents (which increase the excretion of uric acid) are the mainstay of Urate Lowering Therapies. Rarely, Uricase is needed to break down urate crystals rapidly, like in impending acute kidney failure. IL1 inhibition is effective in treating refractory inflammation.