Gout is a chronic metabolic and inflammatory disease whose sine qua non is hyperuricemia. The acute attacks seen in gout are merely the “tip of the iceberg” and represent the effector response to a set of conditions that lead to monosodium urate precipitation and deposition. Moreover, the chronic state of gout is accompanied by co-morbidities that are not resolved when the inflammatory attacks are treated. In consequence, gout must be thought of as a chronic rather than an intermittent condition, and gout treatment should be considered a long-term, and possibly lifelong endeavor. In this brief talk we will consider the chronic nature of gout, as well as current recommendations for chronic gout treatment (diet, lifestyle, and anti-inflammatory and urate-lowering pharmacotherapy), and for assessment of treatment outcomes, including the potential use of imaging. We will also discuss the possibility that good gout treatment initially results in easier gout treatment later on (“debulking”, or Perez-Ruiz’s “dirty dish” hypothesis), and the question of whether “tight control” of gout may have benefit not only for gout, but for gout’s co-morbidities as well.

Disclosure of Interest M. Pillinger Grant/research support from: Savient Pharmaceuticals, Takeda Pharmaceuticals