Adults
Gout: new, uncomplicated
Classic or crystal-proven gout without tophi or CKD 4–5. Many primary care practices start urate-lowering therapy themselves.
What to look for
- Podagra or another typical flare, or crystal-proven gout
- Strong ULT indications: tophi, radiographic damage, or 2 or more flares a year
- Conditional indications: first flare with CKD stage 3 or worse, serum urate above 9 mg/dL, or urolithiasis
What to do
- Treat flares with colchicine, an NSAID or a glucocorticoid.
- Allopurinol is first-line ULT. Start at 100 mg or less daily (lower in CKD), increase every few weeks (often every 2–5 weeks), checking urate after each increase, until it is below 6 mg/dL, and give flare prophylaxis for 3–6 months.
- Consider HLA-B*58:01 testing before allopurinol in patients of Southeast Asian or African American descent.
- Refer if the practice prefers specialist initiation, if the diagnosis is uncertain, or if any complex feature appears.
About this urgency level
These benefit from rheumatology input but are not time-critical. Treatment can often begin, or continue, in primary care while the patient waits.
Timeframes are typical targets. Local pathways, capacity and clinical judgment come first.