Evidence-led writing about managing gout: urate-lowering therapy, uric acid targets, and what the treatment guidelines actually say.https://goutjournal.com/en-gbhttps://goutjournal.com/articles/what-your-gout-snow-picture-means/https://goutjournal.com/articles/what-your-gout-snow-picture-means/The four snow-on-a-roof pictures show whether urate crystals are probably building, shedding, melting or gone, and what may happen next.Thu, 03 Sep 2026 00:00:00 GMTYour uric acid numberNirbhay Agarwalhttps://goutjournal.com/articles/does-drinking-water-help-gout/https://goutjournal.com/articles/does-drinking-water-help-gout/The gout guidelines contain 42 recommendations and not one is about drinking water. Here is what the evidence does and does not support.Wed, 19 Aug 2026 00:00:00 GMTWaterNirbhay Agarwalhttps://goutjournal.com/articles/gout-is-not-a-punishment-for-what-you-ate/https://goutjournal.com/articles/gout-is-not-a-punishment-for-what-you-ate/Diet explains under 1% of the variation in people's uric acid levels. Genetics explains about 24%. Here is what actually sets your number.Wed, 19 Aug 2026 00:00:00 GMTFood and dietNirbhay Agarwalhttps://goutjournal.com/articles/high-uric-acid-but-no-symptoms/https://goutjournal.com/articles/high-uric-acid-but-no-symptoms/Your blood test flagged a high urate level and nothing hurts. The guidelines recommend against treating it — and against ignoring it. Both, for good reasons.Wed, 19 Aug 2026 00:00:00 GMTYour uric acid numberNirbhay Agarwalhttps://goutjournal.com/articles/the-number-that-actually-matters/https://goutjournal.com/articles/the-number-that-actually-matters/Most gout advice is about food. The guidelines are about a number — your serum urate level, and whether it is under the treatment target.Wed, 19 Aug 2026 00:00:00 GMTYour uric acid numberNirbhay Agarwalhttps://goutjournal.com/articles/the-tablet-almost-nobody-keeps-taking/https://goutjournal.com/articles/the-tablet-almost-nobody-keeps-taking/Gout has the worst medication adherence of any common chronic disease — worse than diabetes, blood pressure or cholesterol. The reasons are structural.Wed, 19 Aug 2026 00:00:00 GMTMedicationNirbhay Agarwalhttps://goutjournal.com/articles/what-the-guidelines-say-to-do-in-a-flare/https://goutjournal.com/articles/what-the-guidelines-say-to-do-in-a-flare/Three first-line flare treatments, ranked equal. Low-dose colchicine over high-dose. And the one thing not to do: stop your daily tablet.Wed, 19 Aug 2026 00:00:00 GMTFlaresNirbhay Agarwalhttps://goutjournal.com/articles/when-gout-treatment-stalls-check-the-dose/https://goutjournal.com/articles/when-gout-treatment-stalls-check-the-dose/Allopurinol is meant to start low and then be increased until your uric acid is under target. For a lot of people, the second half never happens.Wed, 19 Aug 2026 00:00:00 GMTMedicationNirbhay Agarwalhttps://goutjournal.com/articles/why-gout-gets-worse-before-it-gets-better/https://goutjournal.com/articles/why-gout-gets-worse-before-it-gets-better/Starting treatment often brings more attacks, not fewer. A snow-on-a-roof analogy from a rheumatology journal explains why — and why it passes.Wed, 19 Aug 2026 00:00:00 GMTMedicationNirbhay Agarwal