Open access. Gout is the most common inflammatory arthritis worldwide, affecting 4·0% of adults in the USA and 2·5% of adults in the UK.1 The pathophysiology of this crystal arthritis is well understood, and inexpensive urate-lowering drugs that address the underlying cause of the disease are widely available. Yet gout remains poorly managed, with 70% of patients experiencing recurrent gout flares2 and substantial burden from tophi and joint damage, which lead to functional limitations and diminished quality of life.