Gout and calcium pyrophosphate disease
Gout flares (NSAID, low-dose colchicine or prednisolone), treat-to-target allopurinol to a urate under 0.36 mmol/L (under 0.30 with tophi), febuxostat and the PBS, and calcium pyrophosphate disease from acute arthritis to crowned dens syndrome.
Tier 1Condition
Written with AI assistance and fact-checked against the sources below. For exam study, not clinical decisions. How notes are made
At a glance
- Gout is the commonest inflammatory arthritis in adults. It is curable: lowering serum urate below its saturation point dissolves the crystals.
- Flares: NSAID, low-dose colchicine or prednisolone, chosen by comorbidity. Don't stop allopurinol during a flare.
- Long term: treat-to-target allopurinol started low and titrated up to a urate under 0.36 mmol/L (under 0.30 with tophi or chronic disease), with colchicine prophylaxis.
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Sources
- Therapeutic Guidelines: Rheumatology (gout; calcium pyrophosphate deposition)AU/NZTherapeutic Guidelines Limited (eTG complete), gout topic December 2024; accessed November 2026
- FitzGerald JD et al. 2020 American College of Rheumatology Guideline for the Management of Gout. Arthritis Care Res 2020;72:744-60American College of Rheumatology, 2020 (current as of November 2026)
- Richette P et al. 2016 updated EULAR evidence-based recommendations for the management of gout. Ann Rheum Dis 2017;76:29-42EULAR, 2016 (current as of November 2026)
- Neogi T et al. 2015 Gout classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative. Ann Rheum Dis 2015;74:1789-98ACR and EULAR, 2015
- Abhishek A et al. The 2023 ACR/EULAR classification criteria for calcium pyrophosphate deposition disease. Ann Rheum Dis 2023;82:1248-57ACR and EULAR, 2023
- Zhang W et al. EULAR recommendations for calcium pyrophosphate deposition. Part II: management. Ann Rheum Dis 2011;70:571-5EULAR, 2011 (current as of November 2026)
- Doherty M et al. Efficacy and cost-effectiveness of nurse-led care involving education and engagement of patients and a treat-to-target urate-lowering strategy versus usual care for gout: a randomised controlled trial. Lancet 2018;392:1403-12The Lancet, 2018
- White WB et al. Cardiovascular safety of febuxostat or allopurinol in patients with gout (CARES). N Engl J Med 2018;378:1200-10New England Journal of Medicine, 2018
- Mackenzie IS et al. Long-term cardiovascular safety of febuxostat compared with allopurinol in patients with gout (FAST). Lancet 2020;396:1745-57The Lancet, 2020
- Terkeltaub RA et al. High versus low dosing of oral colchicine for early acute gout flare (AGREE). Arthritis Rheum 2010;62:1060-8Arthritis and Rheumatism, 2010
- PBS Schedule: febuxostat (Authority Required, chronic gout); DUSC 24-month review of febuxostatAU/NZPharmaceutical Benefits Scheme (Department of Health, Disability and Ageing), restriction as described in the 2018 DUSC review; current Schedule wording not re-verified November 2026
- Colgout (colchicine) Australian product informationAU/NZTherapeutic Goods Administration, 4 June 2026
- Last updated
- 14 November 2026
What changed
- 14 November 2026 Turnstile bot check on sign-in and signed-out feedback