title: Evaluation and treatment of gout as a chronic disease.
abstract: Gout is a disease caused by deposition of monosodium urate crystals in tissues. One of the limitations for successful treatment of gout is to consider it as an intermittent disease rather than a chronic inflammatory disease which, if improperly treated, leads to chronic clinical manifestations. In addition, gout is linked to increased cardiovascular morbidity and mortality.Urate-lowering therapy comprises both nonpharmacologic and pharmacologic interventions, but most patients will need urate-lowering drugs to achieve target therapeutic serum urate levels. Reaching target serum urate levels is associated with improvement in clinical outcomes, including a reduction of acute inflammation episodes, resolution of tophi, and improvement in health-related quality of life perception.A number of urate-lowering drugs are available but a number of patients fail to achieve or maintain therapeutic serum urate levels and go on to develop refractory chronic gout. For such patients, efforts have been made to develop new treatments (e.g., febuxostat or pegloticase).This review intends to increase the awareness of gout as a chronic deposition disease, and show that efforts should be made to properly control serum urate levels in order to achieve complete disappearance of urate crystal deposition.
authors.affiliation: Rheumatology Division, Hospital Universitario Cruces, Pza Cruces, Baracaldo, Vizcaya, Spain. fperezruiz@telefonica.net
authors.forename: Fernando
authors.initials: F
authors.lastname: Perez-Ruiz
authors.forename: Ana Maria
authors.initials: AM
authors.lastname: Herrero-Beites
mesh_terms: D015210:Arthritis, Gouty / Q000097:blood / Q000188:drug therapy / Q000503:physiopathology; D002908:Chronic Disease; D018450:Disease Progression; D005069:Evaluation Studies as Topic; D000069465:Febuxostat; D005260:Female; D005500:Follow-Up Studies; D006073:Gout / Q000097:blood / Q000188:drug therapy* / Q000503:physiopathology*; D006074:Gout Suppressants / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D010147:Pain Measurement; D011092:Polyethylene Glycols / Q000627:therapeutic use; D016032:Randomized Controlled Trials as Topic; D018570:Risk Assessment; D012720:Severity of Illness Index; D013844:Thiazoles / Q000627:therapeutic use; D016896:Treatment Outcome; D014503:Urate Oxidase / Q000627:therapeutic use; D014527:Uric Acid / Q000097:blood* / Q000378:metabolism
chemical_list: D006074:Gout Suppressants; D013844:Thiazoles; D000069465:Febuxostat; D014527:Uric Acid; D011092:Polyethylene Glycols; D014503:Urate Oxidase; C031545:Pegloticase