Table 1 Swedish treatment recommendations [12]

Pharmacological treatment

One gout flare in combination with at least one of the following risk factors for recurrent disease requires long-term pharmacological urate lowering treatment (ULT), sometimes life-long:

• age below 40 years

• urate level > 480 μmol/L

• more than one flare

• multiple joint engagement

• skeletal effects

• comorbidities

• tophi or urate stone

ULT should be increased stepwise in dose to achieve target levels of urate; 360 μmol/L in uncomplicated gout and < 300 μmol/L if tophi are present (normal urate levels without gout are in the range 155–480 μmol/L).

Non-pharmacological interventions

• lifestyle changes, including reduced alcohol consumption

• appropriate diet

• weight loss

• physical activity

• individualised patient education