title: Recent advances in management of gout.
abstract: Incidence and prevalence of gout have markedly increased over the last few decades in keeping with the rise in prevalence of obesity and metabolic syndrome. Until recently, management of gout in patients with associated metabolic syndrome and comorbid illnesses such as renal impairment was difficult because of limited treatment options. However, significant progress has been made in the last few years, with introduction of new treatments such as interleukin-1 antagonists for management of acute gout, and febuxostat and pegloticase for chronic gout. The association of gout with alcohol, dietary purines and fructose ingestion has been confirmed in large prospective studies, thus enabling the clinician to now provide evidence-based advice to patients. Recent efficacy and safety data favour lower over higher doses of colchicine, and oral corticosteroids over non-steroidal anti-inflammatory drugs for patients with acute gout. Local ice therapy might help to differentiate gout from other forms of inflammatory arthritis, and supplementation with vitamin C help to reduce risk of gout. Several other drugs with rational mechanisms of action are in the pipeline, and likely to be introduced over the next few years. A new era has thus begun in the field of gout.
authors.affiliation: Rheumatology Department, Kettering General Hospital, Rothwell Road, Kettering, NN16 8UZ, UK. dr_esuresh@hotmail.com
authors.forename: E
authors.initials: E
authors.lastname: Suresh
authors.forename: P
authors.initials: P
authors.lastname: Das
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000428:Alcohol Drinking / Q000009:adverse effects; D000493:Allopurinol; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D061067:Antibodies, Monoclonal, Humanized; D018501:Antirheumatic Agents / Q000627:therapeutic use; D001205:Ascorbic Acid / Q000627:therapeutic use; D003078:Colchicine / Q000627:therapeutic use; D015897:Comorbidity; D017679:Cryotherapy; D004032:Diet; D004305:Dose-Response Relationship, Drug; D000069465:Febuxostat; D005632:Fructose / Q000009:adverse effects; D006073:Gout / Q000209:etiology / Q000628:therapy*; D006074:Gout Suppressants / Q000627:therapeutic use; D006801:Humans; D053590:Interleukin 1 Receptor Antagonist Protein / Q000627:therapeutic use; D011092:Polyethylene Glycols / Q000627:therapeutic use; D011687:Purines / Q000009:adverse effects; D017472:Receptors, Interleukin-1 / Q000037:antagonists & inhibitors; D011993:Recombinant Fusion Proteins / Q000627:therapeutic use; D013844:Thiazoles / Q000627:therapeutic use; D014503:Urate Oxidase / Q000627:therapeutic use; D014527:Uric Acid / Q000097:blood; D014528:Uricosuric Agents / Q000627:therapeutic use; D014815:Vitamins / Q000627:therapeutic use; D014969:Xanthine Oxidase / Q000037:antagonists & inhibitors
chemical_list: D000305:Adrenal Cortex Hormones; D000894:Anti-Inflammatory Agents, Non-Steroidal; D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D018501:Antirheumatic Agents; D006074:Gout Suppressants; D053590:Interleukin 1 Receptor Antagonist Protein; D011687:Purines; D017472:Receptors, Interleukin-1; D011993:Recombinant Fusion Proteins; D013844:Thiazoles; D014528:Uricosuric Agents; D014815:Vitamins; C469709:rasburicase; D000069465:Febuxostat; D014527:Uric Acid; D005632:Fructose; C541220:canakinumab; D011092:Polyethylene Glycols; D000493:Allopurinol; C531377:rilonacept; D014969:Xanthine Oxidase; D014503:Urate Oxidase; D001205:Ascorbic Acid; C031545:Pegloticase; D003078:Colchicine