RESEARCH ARTICLE


Gout Transitions from Medieval Times into the 21st Century



Puja P. Khanna*
Address correspondence to this author at the Division of Rheumatology, Department of Internal Medicine, 300 North Ingalls, Ste. 7C27, Ann Arbor, MI 48109-5422, USA


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© Puja P. Khanna; Licensee Bentham Open.

open-access license: This is an open access article licensed under the terms of the Creative Commons Attribution-Non-Commercial 4.0 International Public License (CC BY-NC 4.0) (https://creativecommons.org/licenses/by-nc/4.0/legalcode), which permits unrestricted, non-commercial use, distribution and reproduction in any medium, provided the work is properly cited.

* Address correspondence to this author at the Division of Rheumatology, Department of Internal Medicine, 300 North Ingalls, Ste. 7C27, Ann Arbor, MI 48109-5422, USA; E-mail: pkhanna@med.umich.edu


Abstract

Gout is the most treatable arthritis in the Western World—the pathophysiology of which is related to uric acid metabolism and there are effective medications available to treat both acute arthritis and chronic hyperuricemia. Despite this many patients continue to suffer from tophaceous gout with major detrimental effects on patient-reported outcomes and substantial economic impact. Poor adherence to medications is considered an important attribute in developing disability due to gout. This review summarizes recommendations from various national and international guidelines with an update on the therapeutics.

Key Points

  • NSAIDs, COX-2 inhibitors, corticosteroids, colchicine, and IL-1 inhibitors have strong evidence to suggest efficacy in the treatment of acute gout.
  • Urate lowering therapy, with allopurinol or febuxostat as first line agents, is warranted for chronic management of gout.
  • All guidelines recommend a ‘treat-to-target’ strategy to achieve serum urate of at least 6 mg/dL or lower.

Keywords: Allopurinol, corticosteroids, guidelines, gout, treatment update, urate lowering therapy.