Personalizing Gout Management, with Priya Reddy, MD

In this episode of Managing Uncontrolled Gout, rheumatologist Priya Reddy, MD, emphasizes the need for individualized gout management across the disease continuum. Her clinical approach is grounded in the recognition that gout presents variably, and treatment success hinges on tailoring strategies to each patient’s disease stage, comorbidities, and personal goals.

Reddy outlines that patients often seek care at different phases: some during an acute inflammatory flare, others between episodes, and many after long-standing disease has progressed to the development of tophi. These phenotypic differences require clinicians to conduct thorough clinical evaluations, including detailed histories, medication reviews, and physical exams, to accurately identify contributing factors such as diuretic use or comorbid conditions (e.g., metabolic syndrome, renal impairment) that exacerbate hyperuricemia.

She underscores the importance of achieving and maintaining target serum uric acid (sUA) levels, as defined by the American College of Rheumatology—typically ≤6 mg/dL, though some patients may require even lower thresholds for optimal control. Persistent flares or visible tophi are clinical indicators that a patient’s gout remains uncontrolled, warranting therapy escalation or reassessment of adherence, drug access, or pharmacokinetics.

Reddy highlights the frequent disconnect between disease activity and patient behavior. Nonadherence, cost barriers, or polypharmacy can undermine otherwise sound treatment plans. Routine bloodwork, sUA monitoring, and structured patient education can help clinicians troubleshoot barriers, guide dose titration, and reinforce the importance of long-term management to prevent irreversible joint damage and systemic complications.

Ultimately, Reddy conveys that gout is a highly manageable condition when addressed with a proactive, personalized strategy. She encourages clinicians to instill hope in patients, emphasizing that once gout is accurately diagnosed, there is a clear therapeutic path to disease remission and joint preservation.