Topic overview

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Serum urate above 6.8 mg/dL can allow monosodium urate crystals to precipitate in joints and tissues. These crystals provoke inflammation, and recurrent flares may contribute to joint damage and tophi. Risk factors include chronic kidney disease, obesity, certain medicines, alcohol, and purine-rich foods. Management has two related aims: treating acute inflammation and, when indicated, lowering urate over time. The lesson outlines flare therapies, criteria for starting urate-lowering therapy, treatment targets, and the roles of xanthine oxidase inhibitors, uricosuric agents, and recombinant uricase. It also introduces prophylaxis during urate-lowering therapy initiation, key safety concerns, monitoring, lifestyle measures, and how management may be reassessed or escalated.