What is the typical natural history of hyperuricemia leading to gout?
Among those developing gout, most will have an extended period (often ≥20 years) of asymptomatic hyperuricemia preceding symptom-onset. Gout flares are typically the initial symptomatic manifestation and involve a single joint in the vast majority (85%–90%) of patients experiencing their first episode. Subsequent gout flares are typically separated in time by asymptomatic intervals, periods that are termed intercritical gout. It has been estimated that approximately half of individuals experiencing an initial flare will experience a second flare within 1 to 2 years. If left untreated, these intercritical periods often become progressively shorter in duration with a corresponding increase in gout flare frequency. A minority of these individuals may progress to develop tophaceous (advanced) gout, characterized by the progressive development of subcutaneous, synovial, or subchondral MSU deposits. Subcutaneous tophi typically develop after ≥10 years of symptomatic gout that has been inadequately treated, but in rare cases may be apparent at the time of initial diagnosis.
