A literature review of the epidemiology and treatment of acute gout.
BACKGROUND
Gout is the most common cause of inflammatory arthritis in men aged >40 years and is frequently encountered in clinical practice.


OBJECTIVE
The goal of this article was to review the published literature on the epidemiology, treatment, and estimated burden of illness of acute gout.


METHODS
Articles on gout published in English between 1980 and June 2002 were identified through a MEDLINE search. Relevant clinical studies and review articles were found using the text- and keyword-search term gout alone and in combination with epidemiology, prevalence, incidence, complications, outcome, quality of life, economics, cost, prevention or drug therapy. The reference lists of identified articles, especially review articles, were checked for any additional studies that might have been missed in the original MEDLINE search.


RESULTS
The epidemiology of gout in various geographic regions has been well documented. Data suggest that environmental, racial, and hereditary factors may influence the development of gout, and that the prevalence of gout appears to be on the rise worldwide. Evidence from well-designed clinical studies evaluating drug therapies for gout is limited. Therapies for acute gout include corticotropin, corticosteroids, colchicine or, more often, nonsteroidal anti-inflammatory drugs (NSAIDs), which have shown comparable efficacy. A recent study suggests that etoricoxib, a new cyclooxygenase-2-selective inhibitor, may be as effective as and better tolerated than traditional NSAIDs in the treatment of gout. Urate-lowering therapy, prophylactic colchicine, and low-dose NSAIDs are used for the long-term prophylaxis of gout. However, all acute and prophylactic therapies are associated with adverse events. Using an economic model for gout, the annual direct burden of illness for new cases of acute gout can be estimated at 27,378,494 US dollars in the United States.


CONCLUSIONS
Gout is an increasingly prevalent condition worldwide and creates a heavy economic burden. Available treatments are generally effective; however, they are not devoid of adverse events. Well-designed, long-term, controlled clinical trials evaluating the comparative efficacy and tolerability of treatments for gout are needed.
Kim
Karissa Y
KY
Temple University, School of Pharmacy, Philadephia, USA.
Ralph Schumacher
H
H
Hunsche
Elke
E
Wertheimer
Albert I
AI
Kong
Sheldon X
SX
D000208:Acute Disease; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000324:Adrenocorticotropic Hormone / Q000627:therapeutic use; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D002986:Clinical Trials as Topic; D051546:Cyclooxygenase 2; D052246:Cyclooxygenase 2 Inhibitors; D016861:Cyclooxygenase Inhibitors / Q000627:therapeutic use; D006073:Gout / Q000188:drug therapy* / Q000453:epidemiology* / Q000517:prevention & control; D006074:Gout Suppressants / Q000627:therapeutic use; D006801:Humans; D033461:Hyperuricemia / Q000378:metabolism / Q000517:prevention & control; D007527:Isoenzymes / Q000037:antagonists & inhibitors; D008565:Membrane Proteins; D011451:Prostaglandin-Endoperoxide Synthases; D012307:Risk Factors
D000305:Adrenal Cortex Hormones; D000894:Anti-Inflammatory Agents, Non-Steroidal; D052246:Cyclooxygenase 2 Inhibitors; D016861:Cyclooxygenase Inhibitors; D006074:Gout Suppressants; D007527:Isoenzymes; D008565:Membrane Proteins; D000324:Adrenocorticotropic Hormone; D051546:Cyclooxygenase 2; C496540:PTGS2 protein, human; D011451:Prostaglandin-Endoperoxide Synthases