Prognosis

Gout attacks are painful and debilitating, but self-limiting. In patients who have not been treated with uric acid-lowering drugs, the risk of recurrence after the first attack is 62%, 78%, and 84% during the first, second, and third year, respectively.[132]

In untreated gout:[133]

  • About 2% of patients develop severe debilitating arthritis (typically 20 years after the first attack)

  • Tophi occur in about 50% after 10 years, and 72% after 20 years.

Appropriate treatment can suppress gout attacks and their recurrence, and prevent long-term consequences of the disease. There are currently few available uric acid-lowering agents, which is problematic in cases of medication intolerance or ineffectiveness. In addition, treatments for acute and chronic gout have considerable risks and adverse effects.

Data from a general population cohort study suggest that allopurinol initiation modestly reduces risk of death in patients with hyperuricemia and patients with gout.[134] Another study found no difference in mortality in people with incident gout who were treated with allopurinol compared with matched controls, based on propensity scores.[135]

Prospective cohort studies suggest that allopurinol therapy is associated with a reduced incidence of renal disease.[108][109]

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