title: Challenges associated with the management of gouty arthritis in patients with chronic kidney disease: a systematic review.
abstract: OBJECTIVE
  As many as half of all patients with gouty arthritis have some degree of renal impairment. The goal of this systematic review is to provide physicians with a comprehensive examination of available data on the risks and benefits of gouty arthritis treatment options when used in patients with chronic kidney disease (CKD).
  
  
  METHODS
  We conducted a systematic literature review to determine what information is available to guide treatment decisions in this patient population. PubMed was searched for English-language articles indexed through July 2011 containing the terms "gout" or "hyperuricemia" and synonyms for renal impairment in combination with drug names. Publications were deemed relevant if they reported results from clinical studies, case reports, or prescribing practices of the drug of interest in patients with gouty arthritis and CKD.
  
  
  RESULTS
  Nonsteroidal anti-inflammatory drugs and colchicine are oftentimes not considered appropriate in patients with CKD. Corticosteroids may be an effective alternative in this population; however, their efficacy has not been confirmed in randomized controlled trials and these agents can cause serious side effects. Allopurinol can be used for the prophylactic management of chronic hyperuricemia in patients with CKD, but the recommended decreased dosage may limit efficacy and serious hypersensitivity reactions may preclude its use. Febuxostat and pegloticase are new treatment options for chronic urate-lowering prophylaxis; however, the safety of these drugs in patients with advanced CKD has not yet been reported.
  
  
  CONCLUSIONS
  There is currently an unmet need for additional treatment options for the management of gouty arthritis in patients with CKD.
authors.affiliation: The George Washington University, Division of Rheumatology, Washington, DC 20037, USA.
authors.forename: Rodolfo V
authors.initials: RV
authors.lastname: Curiel
authors.forename: Nicolas J
authors.initials: NJ
authors.lastname: Guzman
mesh_terms: D000493:Allopurinol / Q000627:therapeutic use; D000894:Anti-Inflammatory Agents, Non-Steroidal; D015210:Arthritis, Gouty / Q000150:complications / Q000188:drug therapy* / Q000453:epidemiology; D003078:Colchicine; D015897:Comorbidity; D000075202:Contraindications; D000069465:Febuxostat; D005938:Glucocorticoids / Q000627:therapeutic use; D006074:Gout Suppressants / Q000493:pharmacokinetics / Q000627:therapeutic use*; D006801:Humans; D033461:Hyperuricemia / Q000150:complications / Q000188:drug therapy* / Q000453:epidemiology; D011092:Polyethylene Glycols / Q000627:therapeutic use; D011339:Probenecid / Q000627:therapeutic use; D039781:PubMed; D051436:Renal Insufficiency, Chronic / Q000150:complications / Q000188:drug therapy* / Q000453:epidemiology; D055502:Secondary Prevention; D013844:Thiazoles / Q000627:therapeutic use; D014503:Urate Oxidase / Q000627:therapeutic use
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D005938:Glucocorticoids; D006074:Gout Suppressants; D013844:Thiazoles; D000069465:Febuxostat; D011092:Polyethylene Glycols; D000493:Allopurinol; D014503:Urate Oxidase; D011339:Probenecid; C031545:Pegloticase; D003078:Colchicine