Uncontrolled Gout Demands More Than Standard Dosing, with Brittany Panico, DO

In the inaugural installment of the Managing Uncontrolled Gout series, Brittany Panico, DO, offers a focused clinical overview of uncontrolled gout, reframing it as a chronic inflammatory and metabolic disorder—not merely a dietary concern. She highlights the need for increased precision in the diagnosis and management of gout, especially in patients experiencing recurrent flares despite treatment.

Panico explains that hyperuricemia is typically due to impaired renal uric acid excretion, often driven by genetic factors. She uses the analogy of uric acid crystallization forming like “rock candy” to underscore how supersaturation leads to crystal deposition and acute inflammation.

Progression from intermittent flares to uncontrolled gout reflects persistent subtherapeutic urate levels. Even patients prescribed urate-lowering therapy (ULT) may remain undertreated if serum uric acid (sUA) targets are not met. As with hypertension or diabetes, Panico advocates for titration based on biomarker monitoring rather than static dosing. The recommended sUA goal remains <6 mg/dL, and potentially <5 mg/dL in those with tophi or frequent flares.

She also emphasizes the importance of moving beyond lifestyle guidance alone, noting that while high-purine diets, alcohol intake, and obesity may exacerbate gout, the disease’s etiology is largely genetic. Populations with a higher genetic predisposition — such as some Asian and African American groups—warrant earlier screening and intervention.

Untreated or undertreated gout can progress to chronic inflammatory arthritis with irreversible joint damage, reduced renal function, and elevated cardiovascular risk. Panico also urges clinicians to recognize the psychological burden of chronic pain, disability, and stigma, which may lead to anxiety and depression.

Effective gout care requires longitudinal disease monitoring, dose-adjusted ULT, rescue anti-inflammatory strategies, and patient education. Panico advocates for a proactive, empathetic approach to improve adherence and outcomes.