Srpski arhiv za celokupno lekarstvo 2013 Volume 141, Issue 1-2, Pages: 109-115
https://doi.org/10.2298/SARH1302109R
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Novelties in gout
Radak-Perović Marija (Institut za reumatologiju, Beograd)
Zlatković-Švenda Mirjana (Institut za reumatologiju, Beograd)
Chronic asymptomatic hyperuratemia (HUA), gout paroxysm in patients with
chronic hyperuratemia (HU) and normouricemic attacks of gouty arthritis are
well known, but poorly understood. A review of the current literature with
attempt of its explanation is presented. The natural course of gout is
associated with joint structure changes that may be evaluated by different
imaging techniques; comparative advantages and shortcomings of each technique
are presented. For almost over 50 years the market has not offered new drugs
for the control of HU and gout, while management of such patients was a
rather neglected field. Over the last five years an unpredictable number of
prospective clinical studies have been conducted involving the investigation
of the efficacy and safety of new drugs to control HU (febuxostat,
pegloticase). The return of pharmaceutical industry into the world of gout
has considerably changed the picture. New recommendations have been presented
on appropriate colchicine dose regime for acute gouty flares. Emerging
therapies, including pegloticase, uricosuric agent RDEA596 and the
interleukin -1 inhibitors have shown promises in early and late phase
clinical trials. Each of them deserves to be considered for implementation
and feasibility in clinical practice as well as outcome measures for clinical
trials. Another purpose of this review was to summarize new knowledge on
approved drugs to treat hyperuricemia, or the clinical manifestations of
gout. Results of several clinical trials provide new data on the efficacy and
safety of the approved urate lowering drugs (allopurinol and febuxostat).
Lifestyle and dietary recommendations for gout patients should take into
consideration overall health benefits and risks, since gout is often
associated with metabolic syndrome and an increased future risk of
cardiovascular disease and mortality. This review also summarizes the recent
data about lifestyle factors that influence serum uric acid levels and the
gout risk, and attempts to provide holistic recommendations, considering both
their impact on gout as well as on other health implications.
Keywords: gout, pathogenesis of inflammation, imaging techniques, pharmacotherapy, lifestyle