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Pathophysiology, clinical presentation and treatment of gout
Gim Gee Teng1, Raj Nair, Kenneth G Saag
1Department of Medicine, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, Alabama 35294-3296, USA.
Insights
Gout, a common inflammatory arthritis, is increasing in prevalence. Effective management involves diagnosing stages, modifying risk factors, and utilizing pharmacotherapies, with new drugs improving treatment options.
Area of Science:
- Rheumatology
- Internal Medicine
- Public Health
Background:
- Gout is a prevalent inflammatory arthritis with increasing prevalence, posing a significant public health challenge.
- Accurate diagnosis and understanding of gout's stages and manifestations are crucial for effective management.
- Emerging evidence is refining the understanding of gout risk factors.
Purpose of the Study:
- To provide an overview of gout diagnosis, risk factors, and management strategies.
- To discuss current and emerging pharmacotherapeutic options for gout.
- To highlight the importance of patient adherence and education in managing gout.
Main Methods:
- Review of current medical literature on gout prevalence, risk factors, and treatment.
- Analysis of pharmacotherapy for acute flares and long-term urate lowering.
- Discussion of challenges and advancements in gout treatment.
Main Results:
- Gout prevalence is rising, necessitating better public health strategies.
- Management involves risk factor modification, treating acute flares (NSAIDs, glucocorticoids), and long-term urate-lowering therapy.
- Newer drugs like febuxostat and uricase offer improved options for refractory or intolerant patients.
Conclusions:
- Gout is effectively manageable with early intervention, monitoring, and patient education.
- Understanding pathogenesis and utilizing novel therapies enhance treatment outcomes, especially for difficult-to-treat cases.
- Addressing patient adherence and drug use errors is vital for successful gout management.
Abstract:
Gout is a common form of inflammatory arthritis that has been managed primarily in general medical practices for centuries. It appears that there has been an increasing prevalence of gout over the past decades, implying a growing public health burden. Accurate diagnosis and recognition of the various stages and manifestations of gout enable realistic goal setting for management. Recent evidence suggests new risk factors and potentially refutes others. Management of gout requires characterising and modifying risk factors and associated disorders, and commonly initiating drug therapy. Pharmacotherapy of gout includes the management of acute flares with anti-inflammatory agents such as NSAIDs and glucocorticoids and long-term treatment with urate-lowering drugs. Although pharmacotherapy is generally safe and effective, there are caveats and limitations to all gout therapies. Patient non-adherence and errors with the use of drugs for gout treatment are important factors leading to medical failures. With early intervention, careful monitoring and patient education, gout is a condition that can be managed very effectively. The advent of new drugs (such as febuxostat and urate oxidase [uricase]) and enhanced understanding of the pathogenesis of gout continue to improve our therapeutic options, particularly in a subset of patients with refractory disease and those who are intolerant to currently available medications.
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