Gout: a review of its aetiology and treatment.
OBJECTIVE
To review the current understanding of the causes and the management of gout.


METHODS
Publications on all peer-review literature from MEDLINE from 1965 to January 2004.


METHODS
Selected and evaluated by the author.


METHODS
Extracted and evaluated by the author.


RESULTS
The underlying metabolic disorder in gout is hyperuricaemia. Most patients with hyperuricaemia remain asymptomatic throughout their lifetime. The phase of asymptomatic hyperuricaemia ends with the first attack of gouty arthritis or urolithiasis. The risk of gout and stone formation is increased with the degree and duration of hyperuricaemia. Drugs available for the treatment of acute gouty arthritis, such as non-steroidal anti-inflammatory drugs, selective cyclo-oxygenase 2 inhibitors, systemic corticosteroids, or colchicine, are effective. For periods between attacks, prophylactic therapy, such as low-dose colchicine, is effective. In those with recurrent attacks of more than two to three times yearly, a uric acid-lowering agent as a long-term therapy should be considered to avoid recurrence and the development of tophaceous gout.


CONCLUSIONS
Effective management of gout can be achieved through better understanding of the causes of the condition, preventive measures as well as drug treatment.
Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong. edmundli@cuhk.edu.hk
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D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D015210:Arthritis, Gouty / Q000209:etiology / Q000628:therapy; D003078:Colchicine / Q000627:therapeutic use; D016861:Cyclooxygenase Inhibitors / Q000627:therapeutic use; D004035:Diet Therapy; D005260:Female; D006073:Gout / Q000150:complications / Q000209:etiology* / Q000628:therapy*; D006074:Gout Suppressants / Q000627:therapeutic use; D006333:Heart Failure / Q000150:complications; D006801:Humans; D033461:Hyperuricemia / Q000150:complications; D007676:Kidney Failure, Chronic / Q000150:complications; D008297:Male; D011687:Purines / Q000378:metabolism; D014969:Xanthine Oxidase / Q000037:antagonists & inhibitors
D000305:Adrenal Cortex Hormones; D000894:Anti-Inflammatory Agents, Non-Steroidal; D016861:Cyclooxygenase Inhibitors; D006074:Gout Suppressants; D011687:Purines; D014969:Xanthine Oxidase; D003078:Colchicine