#112 Gout Flares: Bathtubs and Firefighting

Gout management requires distinguishing acute flares from other inflammatory conditions through clinical assessment, as crystal-proven diagnosis remains uncommon in primary care. Elevated serum urate is a necessary but insufficient cause of gout, with renal urate transport abnormalities serving as the primary driver rather than dietary intake. Effective treatment of acute flares involves managing intense inflammation using corticosteroids, colchicine, or IL-1 inhibitors, while avoiding patient shaming regarding lifestyle choices. When treating, clinicians should prioritize patient education using the "bathtub" analogy to explain the need for both acute flare management and long-term urate-lowering therapy. Although classification criteria exist for research, they function as educational tools rather than definitive diagnostic standards. Future management strategies may include point-of-care ultrasound to identify double contour signs, though clinical diagnosis remains the cornerstone of practice for most providers.