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Rheumatology · London

A private gout clinic, by a specialist rheumatologist.

Definitive diagnosis by polarised microscopy or DECT, an acute flare settled the same visit, and a treat-to-target urate-lowering plan set to BSR and EULAR standards. Refractory options, including canakinumab and pegloticase, when the usual drugs are not enough.

A radiographer guides a patient onto the bed of an advanced 3 Tesla MRI scanner in a London imaging suite

Indicative pricing

What a private gout clinic costs in London.

Indicative ranges across our partner rheumatology units.

In short

£450 to £1,400, most patients on allopurinol at £15 to £45 per month.

Service Indicative range
Initial rheumatology consultation with serum urate £450–£850
Joint aspiration with polarised microscopy £350–£550
Dual-energy CT (DECT) for urate deposition £550–£950
Intra-articular steroid injection £250–£450
Urate-lowering therapy (allopurinol or febuxostat) £15–£45/mo
Canakinumab (Ilaris) subcutaneous, refractory gout £4,500–£8,500
Pegloticase (Krystexxa) intravenous, refractory gout £3,500–£5,500
Follow-up review with urate and eGFR £220–£380

Prices vary by consultant, by whether same-day aspiration or DECT is needed, and by ULT choice. Canakinumab and pegloticase are reserved for refractory disease and quoted per dose.

The journey

From first flare to a stable urate target, in order.

One rheumatologist from acute attack through titration to long-term treat-to-target review.

  1. 04

    On the day

    Consultation and diagnostics

    A 45 to 60 minute consultation with the rheumatologist. Joint aspiration with polarised microscopy the same visit if a joint is inflamed. DECT booked if indicated.

  2. 05

    On the day

    Acute attack settled

    If in a flare: NSAID plus PPI, low-dose colchicine, oral prednisolone, or an intra-articular steroid injection. Canakinumab reserved for refractory cases.

  3. 06

    After

    Urate-lowering therapy started

    Allopurinol titrated monthly from 100 mg to target serum urate below 300 micromol per litre. Prophylactic colchicine for six months to prevent flare on initiation.

  4. 07

    After

    Treat-to-target review

    Urate checked at 4 weeks after each dose change, then every 6 months once stable. Tophi and comorbidities reviewed at 6 and 12 months.

When a private gout clinic helps

The presentations we see, and the red flags we do not miss.

When to move from primary care allopurinol to a specialist plan, and the situations where gout is not the only possible diagnosis.

  • Recurrent acute flares (2 or more per year)

    BSR and EULAR indication for lifelong urate-lowering therapy to a target of below 360 micromol per litre, or below 300 with tophi.

  • Tophaceous gout

    Visible or palpable tophi at the ear, fingers, olecranon or Achilles. Target urate below 300 micromol per litre to shrink deposits.

  • Chronic urate arthropathy

    Established joint damage on plain film or MRI, or persistent low-grade synovitis between flares. DECT quantifies deposition.

  • Gout with CKD stage 3 or worse

    Careful allopurinol titration, febuxostat if intolerant, and avoidance of NSAIDs. HLA-B*5801 screening for high-risk populations.

  • Urolithiasis or uric acid stones

    Recurrent stones with a uric acid component are a firm indication for ULT and urinary alkalinisation.

  • Young-onset gout (under 40)

    Early presentation warrants ULT to prevent decades of joint damage. Underlying metabolic causes are looked for.

  • Diagnostic uncertainty (pseudogout, septic joint)

    A hot swollen joint is not always gout. Aspiration with polarised microscopy and Gram stain distinguishes MSU from CPPD or infection.

  • Red flag: fever with hot single joint

    Septic arthritis must be excluded on the day. Aspiration and fluid culture take priority over any presumed gout diagnosis.

Treatment options

Acute flare, urate-lowering therapy, and the refractory ladder.

BSR, EULAR and ACR-aligned choices. Uricosurics such as probenecid and imported benzbromarone are second-line. Lesinurad has been withdrawn.

  • Acute flare: NSAID plus PPI

    Naproxen 500 mg twice daily with a proton-pump inhibitor if renally suitable. First-line for the fit adult without CKD, heart failure or peptic ulcer history.

  • Acute flare: low-dose colchicine

    Colchicine 500 micrograms twice or three times daily under the newer BSR and ACR low-dose regime. Fewer GI side effects than historical high-dose schedules.

  • Acute flare: oral prednisolone

    Prednisolone 30 to 40 mg daily for 5 days when NSAIDs and colchicine are contraindicated. Preferred in CKD, on anticoagulation, or with peptic ulcer risk.

  • Intra-articular steroid injection

    A single injection of methylprednisolone or triamcinolone settles a large-joint monoarthritis rapidly, once infection has been excluded on aspiration.

  • Canakinumab (Ilaris) IL-1 blocker

    Subcutaneous IL-1 beta antibody for refractory or contraindicated conventional therapy. NICE TA451 does not routinely fund it, so private funding is usual.

  • Allopurinol treat-to-target ULT

    First-line urate-lowering therapy. Start 100 mg (50 mg in CKD), escalate monthly by 100 mg to target serum urate below 300 or 360 micromol per litre.

  • Febuxostat (Uloric) 80 to 120 mg

    NICE TA164 alternative when allopurinol is not tolerated or ineffective. Carries an FDA cardiovascular warning, so cardiac history is reviewed first.

  • Pegloticase (Krystexxa) IV, 6-monthly

    Recombinant uricase infusion for tophaceous gout refractory to all oral options. Rapidly clears crystal load but requires infusion monitoring.

Safety and monitoring

What to expect on urate-lowering therapy - honestly.

Gout treatment is a long game. The things worth planning are HLA-B*5801 screening, prophylactic colchicine, renal monitoring, and disciplined treat-to-target titration.

  • HLA-B*5801 testing before allopurinol

    Screen Han Chinese, Thai and Korean patients before starting allopurinol. Carriers have a much higher risk of Stevens-Johnson syndrome and toxic epidermal necrolysis.

  • Colchicine prophylaxis for 6 months

    Colchicine 500 micrograms once or twice daily during ULT initiation prevents the paradoxical flare that comes with a falling urate. Stop earlier only if intolerant.

  • Renal function drives ULT dosing

    Allopurinol starts at 50 to 100 mg in eGFR under 60 and titrates slowly. Febuxostat and NSAIDs need caution in CKD. eGFR is checked before each escalation.

  • Febuxostat cardiovascular warning

    The CARES trial and FDA advisory flagged a signal for cardiovascular death versus allopurinol. Prior MI or stroke is a relative contraindication.

  • Comorbidity screening at diagnosis

    Hypertension, type 2 diabetes, dyslipidaemia and obesity are screened and treated alongside gout. Loop and thiazide diuretics are reviewed and swapped where possible.

  • Dietary and alcohol advice

    Reduce red meat, shellfish, beer and fructose-sweetened drinks. Low-fat dairy is protective. Cherry intake has modest supporting evidence. Coffee is neutral.

  • SGLT2 inhibitors as adjunct

    In gout with type 2 diabetes or heart failure, SGLT2 inhibitors lower serum urate by 30 to 60 micromol per litre and reduce flare rate as a bonus effect.

  • Treat-to-target, not treat-to-symptom

    ULT is titrated to a urate number, not to how the patient feels. Under-dosed allopurinol at 300 mg is the single commonest reason gout keeps flaring.

  • Red flags after initiation

    A widespread rash, mouth ulcers, fever or eosinophilia in the first 8 weeks of allopurinol needs same-day review. Stop the drug and contact the clinic.

Reading your rheumatology letter

Your gout plan in four parts. Read the last one first.

Whichever consultant sees you, the letter keeps to the same shape.

  1. 01 Header

    Diagnosis and crystal confirmation

    Whether MSU crystals were seen on polarised microscopy, DECT findings, and serum urate at presentation. This anchors the whole plan.

  2. 02 Acute plan

    Flare treatment and any injection given

    The drug used, its dose, duration, and any intra-articular injection. Contraindications considered and why the choice was made.

  3. 03 ULT plan

    Urate target and titration schedule

    Your urate target (below 300 or 360), starting dose, monthly escalation, and the prophylactic colchicine plan for the first six months.

  4. 04 Impression

    Comorbidity review and follow-up interval

    Read this first: renal function, cardiovascular risk, diuretic swap, HLA-B*5801 status if relevant, and when to be seen again.

Recognised by major UK insurers

BupaAXA HealthVitalityAvivaWPACignaHealixBupaAXA HealthVitalityAvivaWPACignaHealixBupaAXA HealthVitalityAvivaWPACignaHealix

Cover for gout consultations and ULT varies by insurer. Canakinumab and pegloticase are usually self-funded.

Frequently asked

Everything we get asked about private gout care.

Quick answers on diagnosis, acute flares, ULT thresholds and the newer refractory options.

  • How is gout diagnosed definitively?

    The gold standard is joint aspiration with polarised microscopy showing negatively birefringent needle-shaped monosodium urate crystals in synovial fluid. Serum urate above 360 micromol per litre supports the diagnosis but can be normal during an acute flare, so a single blood test does not rule gout in or out. Dual-energy CT (DECT) can visualise urate deposits non-invasively and is useful when aspiration is not possible. Ultrasound can show the double contour sign over hyaline cartilage.

  • How is an acute gout flare treated?

    First-line is a non-steroidal anti-inflammatory such as naproxen 500 mg twice daily with a proton-pump inhibitor, provided renal function and cardiac history allow. Second-line is low-dose colchicine 500 micrograms twice or three times daily under the newer BSR and ACR regime. If both are contraindicated, oral prednisolone 30 to 40 mg for 5 days works well. A single intra-articular steroid injection is excellent for a large monoarthritis once infection has been excluded. Canakinumab is reserved for truly refractory cases.

  • When should urate-lowering therapy be started?

    BSR and EULAR recommend starting ULT after two or more flares per year, in anyone with tophi, chronic urate arthropathy, CKD stage 3 or worse, uric acid urolithiasis, or young-onset gout under the age of 40. Allopurinol is first-line, started at 100 mg (50 mg in CKD) and titrated monthly to a serum urate target of below 300 micromol per litre with tophi, or below 360 without.

  • Why do I need HLA-B*5801 testing?

    Carriers of HLA-B*5801 have a substantially higher risk of a life-threatening skin reaction (Stevens-Johnson syndrome or toxic epidermal necrolysis) with allopurinol. The allele is common in Han Chinese, Thai and Korean populations, so screening is standard before allopurinol in high-risk ethnic groups. If positive, febuxostat is used instead.

  • How much does a private gout clinic cost in the UK?

    A first rheumatology consultation with serum urate is £450 to £850. Joint aspiration with polarised microscopy is £350 to £550. Dual-energy CT is £550 to £950 upfront. Urate-lowering therapy with allopurinol or febuxostat costs £15 to £45 per month. Refractory options are considerably more: canakinumab is £4,500 to £8,500 per dose privately, pegloticase £3,500 to £5,500 per infusion.

  • Does diet really matter, or is it all genetic?

    Both matter. Gout is largely inherited through kidney urate transporters, and diet alone rarely lowers urate by more than 60 micromol per litre. Reducing red meat, shellfish, beer and fructose-sweetened drinks helps, low-fat dairy is protective, and cherries have modest evidence. But dietary change is an adjunct, not a substitute, for treat-to-target urate-lowering therapy. In gout with type 2 diabetes or heart failure, an SGLT2 inhibitor now offers real urate-lowering benefit as a bonus.

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