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Gout is now the commonest type of inflammatory arthritis despite availability of safe, effective and potentially \u2018curative\u2019 urate-lowering drugs. Modern imaging studies show that gout is a chronic inflammatory crystal deposition disorder even at the first acute attack and they illuminate the need to eliminate urate crystals by continuing reduction of the serum urate below its solubility threshold. Clinical outcomes, adherence to therapy and quality of gout care in primary care and hospital practice can be greatly improved by better use of allopurinol and flare prophylaxis, greater patient engagement, education and follow-up, and by nurse-led models of care that employ a \u2018treat-to-target\u2019 principle (SUA&lt; 360 or 300\u03bcmol\/l). Advances in understanding the physiology and genetic control of urate transport in the kidney and gut have led to novel, more selective uricosuric drugs, and basic research on mediators of urate crystal-induced inflammation has pointed to alternative therapeutic targets for treating and preventing gout flares. Current guidelines for the management of gout and indications for the use of some more recently introduced drugs; febuxostat, lesinurad, pegloticase and interleukin-1 antagonists are also briefly reviewed.<\/jats:p>","DOI":"10.4997\/jrcpe.2020.209","type":"journal-article","created":{"date-parts":[[2020,6,18]],"date-time":"2020-06-18T10:27:56Z","timestamp":1592476076000},"page":"124-132","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":5,"title":["Changing Paradigms in the Management of Gout"],"prefix":"10.1177","volume":"50","author":[{"given":"George","family":"Nuki","sequence":"first","affiliation":[{"name":"Emeritus Professor of Rheumatology, University of Edinburgh, United Kingdom"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Philip","family":"Riches","sequence":"additional","affiliation":[{"name":"Senior Lecturer\/Consultant Rheumatologist, Western General Hospital, Edinburgh, United Kingdom."}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2020,6,1]]},"reference":[{"key":"bibr1-jrcpe.2020.209","doi-asserted-by":"publisher","DOI":"10.1038\/nrrheum.2015.91"},{"key":"bibr2-jrcpe.2020.209","doi-asserted-by":"publisher","DOI":"10.1002\/art.40807"},{"key":"bibr3-jrcpe.2020.209","doi-asserted-by":"publisher","DOI":"10.1093\/rheumatology\/kes253"},{"key":"bibr4-jrcpe.2020.209","doi-asserted-by":"publisher","DOI":"10.3899\/jrheum.170381"},{"key":"bibr5-jrcpe.2020.209","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2016.3517"},{"key":"bibr6-jrcpe.2020.209","doi-asserted-by":"publisher","DOI":"10.1093\/rheumatology\/ket265"},{"key":"bibr7-jrcpe.2020.209","doi-asserted-by":"publisher","DOI":"10.1186\/s12916-017-0890-9"},{"key":"bibr8-jrcpe.2020.209","doi-asserted-by":"publisher","DOI":"10.1136\/rmdopen-2019-001015"},{"key":"bibr9-jrcpe.2020.209","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2012-201687"},{"key":"bibr10-jrcpe.2020.209","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(14)60460-8"},{"key":"bibr11-jrcpe.2020.209","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2013-204463"},{"key":"bibr12-jrcpe.2020.209","first-page":"104","volume":"33","author":"Neogi T","year":"2006","journal-title":"J Rheumatol"},{"key":"bibr13-jrcpe.2020.209","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2014.14484"},{"key":"bibr14-jrcpe.2020.209","doi-asserted-by":"publisher","DOI":"10.1002\/acr.22469"},{"key":"bibr15-jrcpe.2020.209","doi-asserted-by":"publisher","DOI":"10.1002\/acr.21773"},{"key":"bibr16-jrcpe.2020.209","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2016-209707"},{"key":"bibr17-jrcpe.2020.209","doi-asserted-by":"publisher","DOI":"10.1093\/rheumatology\/kex156"},{"key":"bibr18-jrcpe.2020.209","doi-asserted-by":"publisher","DOI":"10.1002\/art.10511"},{"key":"bibr19-jrcpe.2020.209","doi-asserted-by":"publisher","DOI":"10.1002\/art.20405"},{"key":"bibr20-jrcpe.2020.209","first-page":"109","volume":"2","author":"Fang P","year":"2013","journal-title":"Brain Disord Ther"},{"key":"bibr21-jrcpe.2020.209","doi-asserted-by":"publisher","DOI":"10.7326\/M16-0570"},{"key":"bibr22-jrcpe.2020.209","doi-asserted-by":"publisher","DOI":"10.1002\/art.40233"},{"key":"bibr23-jrcpe.2020.209","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2011.1169"},{"key":"bibr24-jrcpe.2020.209","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(18)32158-5"},{"key":"bibr25-jrcpe.2020.209","doi-asserted-by":"publisher","DOI":"10.7812\/TPP\/15-234"},{"key":"bibr26-jrcpe.2020.209","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjmed.2018.11.011"},{"key":"bibr27-jrcpe.2020.209","doi-asserted-by":"publisher","DOI":"10.1002\/acr.23544"},{"key":"bibr28-jrcpe.2020.209","doi-asserted-by":"publisher","DOI":"10.1136\/ard.2011.154997"},{"key":"bibr29-jrcpe.2020.209","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2014-206397"},{"key":"bibr30-jrcpe.2020.209","doi-asserted-by":"publisher","DOI":"10.1136\/ard.2007.076232"},{"key":"bibr31-jrcpe.2020.209","doi-asserted-by":"publisher","DOI":"10.1592\/phco.28.4.437"},{"key":"bibr32-jrcpe.2020.209","doi-asserted-by":"publisher","DOI":"10.1186\/s13075-016-1211-y"},{"key":"bibr33-jrcpe.2020.209","doi-asserted-by":"publisher","DOI":"10.1016\/j.semarthrit.2014.01.004"},{"key":"bibr34-jrcpe.2020.209","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2016-210872"},{"key":"bibr35-jrcpe.2020.209","volume":"351","author":"Ko T-M","year":"2015","journal-title":"BMJ"},{"key":"bibr36-jrcpe.2020.209","unstructured":"US Food and Drug Administration. 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