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The management of gout
Andrew Finch Rheumatology1, , Paul Kubler Rheumatologist1
1Royal Brisbane and Women's Hospital, Brisbane.
Australian Prescriber
|October 21, 2016
Summary
Gout, an inflammatory arthritis caused by urate crystal deposition, is increasingly common. Acute gout management includes NSAIDs, colchicine, or corticosteroids, while allopurinol and febuxostat lower uric acid levels.
Area of Science:
- Rheumatology
- Immunology
- Pharmacology
Background:
- Gout is a prevalent inflammatory arthritis resulting from monosodium urate crystal deposition.
- Increasing prevalence highlights the need for effective management strategies.
- Understanding the pathophysiology is crucial for targeted therapeutic interventions.
Approach:
- Review of current pharmacological treatments for acute gout flares.
- Analysis of urate-lowering therapies, including xanthine oxidase inhibitors and uricosurics.
- Discussion of factors influencing drug selection, such as comorbidities and renal function.
Key Points:
- Non-steroidal anti-inflammatory drugs, colchicine, and corticosteroids are equally effective for acute gout, with choices guided by patient comorbidities.
- Allopurinol and febuxostat are xanthine oxidase inhibitors that effectively reduce serum uric acid levels.
- Renal function and baseline uric acid levels are critical for dosing allopurinol; probenecid and emerging uricosurics enhance uric acid excretion.
Conclusions:
- Optimal management of gout involves addressing acute flares and reducing uric acid levels.
- Personalized treatment approaches considering individual patient factors are essential.
- Future therapeutic options, including novel uricosuric drugs, promise improved outcomes for refractory cases.
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