Gout

• Acute attack — start within 24 h: Colchicine, Naproxen, Etoricoxib, Prednisolone
• Long term (urate below 6 mg/dL): Allopurinol, Colchicine cover (when starting allopurinol), Febuxostat (second line; avoid with heart disease)

First visit

• Serum uric acid — May be normal during an attack — repeat 2–4 weeks after.
• Creatinine — Before NSAIDs, colchicine and allopurinol dosing.

Only if indicated

• Joint aspiration for crystals and culture — First attack or any hot joint where infection is possible.
• X-ray of the joint — Chronic gout (tophi, erosions).
• Blood glucose, lipids, BP — Associated metabolic disease.
• HLA-B*58:01 — Before allopurinol where available (severe skin reactions).

Follow-up and monitoring

• Uric acid every 2–4 weeks while increasing allopurinol — Target under 6 mg/dL, then every 6 months.