Gout: an animated, cited guide

This page needs JavaScript for its animations. The outline and key answers are below, and every claim in the full version carries a numbered citation.

Not medical advice. Gout Companion is an educational synthesis of published literature. It does not replace a clinician.

What is in it

What gout is Who gets it, the numbers, and the four stages from high urate to tophi.
Where urate comes from Purines, xanthine oxidase, and how the kidney and gut handle urate.
Crystals vs serum urate Why crystals form above about 6.8 mg/dL and dissolve below the target.
A flare, hour by hour From a shed crystal to the NLRP3 inflammasome, interleukin-1β and neutrophils, then resolution.
Colchicine inside the cell From the pill to the neutrophil to the microtubule.
Treating a flare Colchicine, NSAIDs, glucocorticoids, IL-1 blockers and ice.
Colchicine dosing and safety Published doses, kidney function and drug interactions.
How urate-lowering drugs work Allopurinol, febuxostat, uricosurics and pegloticase.
Treat to target Titrating to below 6 mg/dL, and why flares rise in the first months.
Safety of urate-lowering drugs HLA-B*58:01, the CARES and FAST trials, interactions.
Diagnosis and the ACR/EULAR score Crystals under polarised light, imaging, and the 2015 classification calculator.
The differential Calcium pyrophosphate crystal arthritis, septic arthritis, cellulitis and others.
Gout, kidneys and heart Chronic kidney disease, stones, blood pressure and cardiovascular risk.
Living with gout Diet, alcohol, weight, other medicines and a flare plan.
Nursing care Assessment, giving the medicines, teaching and documentation.
Toward a cure Dissolving crystals for good, and the research pipeline.
History and people From podagra to polarised light and allopurinol.
Flashcards, quiz and glossary Revision for students.
Sources Every reference behind the app.

Part 1 · The disease

Where urate comes from

Urate is the end product of purine breakdown in humans: xanthine oxidase makes it, and the kidneys and gut clear it, about two thirds and one third. ^39,302 In most people with gout the problem is the way out, not the way in. Press play to follow a purine from a cell to the urine.

ABCG2 Balance (scene 5)

Scene

Schematic, not to scale.

The transporters and enzymes, one by one

Tap a name to light it up in the animation and read what it does, what goes wrong, and which drugs act on it. ¹⁵³

Pick one

In plain wordsKidney cells have doors on both sides. Some doors pull urate back into the blood; others push it out into the urine. Genes decide how many doors work and how well. ^153,412

Genes or diet?

Why did apes lose uricase?

Losing the same gene more than once suggests the loss helped. Every explanation on offer is still a hypothesis. ^297,434

Types of high urate

Type	What happens	How common	Examples

Urate above about 6.8 mg/dL (405 µmol/L) is more than plasma can hold at body temperature. ²⁴⁹ What happens next is in Crystals vs serum urate; the drugs that act on this map are in How urate-lowering drugs work.