Gout therapy updated
Abstract
Gout is a common and painful inflammatory arthritis caused by monosodium urate crystal deposition into joints in the setting of hyperuricemia. Recent reports indicate an increase in prevalence and incidence of gout worldwide. While genetics, dietary habits, and lifestyle play a significant role in the development of gout, risk factors also include diabetes, hypertension, obesity, chronic kidney disease, and metabolic disease among others. As such, accompanying comorbidities must also be considered when choosing therapeutic agents for urate-lowering therapy (ULT) and gout flares. This article will focus on reviewing gout pathophysiology and discussion of currently available pharmacological and nonpharmacological options for chronic gout management, gout flare therapy, and prophylactic measures. Despite an increase in prevalence, optimal gout management remains elusive and challenging with only a third to half of patients receiving definitive treatment and fewer than half of patients remaining adherent to treatment. Current strategies for optimal chronic gout management include the "treat to target" method, which focuses on targeting serum urate level of 5-6 mg/dL or lower. Additional approaches for chronic gout management include starting ULTs with 3-6 months of prophylaxis to reduce the risk of precipitating gout flares during initiation. Both improvement of the recognition and diagnosis of gout and more widespread provider adherence to international rheumatology society…
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