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Therapeutics of hyperuricaemia and gout

Environmental factors, including diet, fluid intake and alcohol consumption, often contribute significantly to the development of hyperuricaemia. The contribution of these factors, together with body size and the renal excretory capacity for urate, can be assessed on the basis of the clinical history and examination, together with simple investigations. These include the measurement of both serum levels of urate and the urinary excretion of urate, and the effect of purine restriction on these measurements. Recognition of causative factors provides the potential for their correction. Should gout develop, serum urate levels must be reduced to normal. This usually, but not invariably, necessitates prolonged drug treatment. The major problem in maintaining serum urate levels within the normal range is that this depends upon the cooperation of the patient. Acute gout needs to be managed on its own merits, irrespective of the use of drugs which alter the serum urate concentration. Prophylactic therapy with colchicine reduces the frequency of acute attacks of gout, whether the serum urate level is normal or elevated.