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[Gout, beyond the joint: How should we treat it?]
M A Pou1, D Martinez-Laguna2, C Diaz-Torne3
1EAP Encants, Institut Català de la Salut, Barcelona, España; Grupo de Investigación en Enfermedades del Aparato Locomotor en Atención Primaria (GREMPAL).
Semergen
|February 1, 2024
Summary
Gout management is poor despite advances, with genetics and kidney function being key factors. Effective treatment involves lowering uric acid levels to below 6mg/dl to dissolve crystals and cure the disease.
Area of Science:
- Rheumatology
- Nephrology
- Cardiology
Background:
- Gout, caused by monosodium urate crystal deposition, is often poorly managed due to its presentation and misconceptions.
- Despite increased knowledge, less than 30% of gout patients receive adequate treatment.
- Prevalence in Spain is 2.5% and rising, underscoring a significant public health issue.
Purpose of the Study:
- To review the pathogenesis of gout and hyperuricemia.
- To emphasize the roles of genetics and renal function over diet.
- To discuss gout's systemic consequences, including cardiovascular risk.
Main Methods:
- Review of current literature on gout pathogenesis, crystal deposition, and treatment strategies.
- Analysis of factors influencing hyperuricemia, including genetic and renal aspects.
- Examination of therapeutic approaches, focusing on hypouricemic agents.
Main Results:
- Genetics and renal function significantly influence hyperuricemia more than diet.
- Gout is an independent cardiovascular risk factor beyond joint and renal manifestations.
- Sustained uricemia below 6mg/dl is crucial for dissolving crystals and achieving disease remission.
Conclusions:
- Hypouricemic therapy is the cornerstone for gout treatment, aiming for crystal dissolution and cure.
- Comprehensive management includes addressing cardiovascular risks, preventive measures, flare treatment, and patient education.
- Optimizing patient adherence to lifestyle modifications and pharmacotherapy is essential for long-term gout control.
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