Managing Gout Beyond the Flare: Clinical Insights for Sustained Control

In this episode of Managing Uncontrolled Gout, nurse practitioner Polly Bittle, APRN, FNP-C (Tampa Bay Nephrology Associates) and rheumatologist Angela Crowley, MD (Hinsdale Orthopedics) discuss the multifaceted management of uncontrolled gout, emphasizing its systemic implications and the need for coordinated care across specialties.

Bittle reiterates that gout is not simply a joint disorder but a metabolic condition driven by hyperuricemia and exacerbated by comorbidities such as CKD, hypertension, and metabolic syndrome. She cautions that many patients misattribute initial symptoms to aging or osteoarthritis, delaying diagnosis and appropriate therapy. Although dietary purine intake can precipitate flares, she emphasizes that lifestyle modifications alone are insufficient for disease control. Treatment must be pharmacologically driven, including urate-lowering therapies (ULT), anti-inflammatory agents, and hydration guidance. Bittle stresses routine uric acid monitoring and patient education to prevent progression to tophaceous disease or irreversible joint damage.

Crowley highlights the systemic burden of untreated gout, noting that urate crystals deposit not only in joints but also in the kidneys and vascular tissues, contributing to elevated risks for nephrolithiasis, CKD progression, cardiovascular disease, and stroke. She challenges the enduring misconception that gout is merely a dietary issue, advocating for a more comprehensive treatment paradigm that integrates patient adherence, longitudinal care, and interdisciplinary collaboration.

Both clinicians underscore the importance of early intervention, patient-provider communication, and adherence to a “treat-to-target” model—maintaining serum urate <6 mg/dL—to prevent flares and systemic sequelae. They recommend engaging rheumatology and nephrology when managing refractory or comorbid presentations and encourage clinicians to educate patients that gout is a chronic, systemic condition requiring proactive management.

Their shared message is clear: uncontrolled gout is not benign, but it is manageable with appropriate clinical oversight and patient engagement.