Elsevier

Joint Bone Spine

Volume 76, Issue 4, July 2009, Pages 444-446
Joint Bone Spine

Gout Study Group: Update on hyperuricemia and gout

https://doi.org/10.1016/j.jbspin.2009.05.006Get rights and content

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Which comorbidities should be stressed in gout?

It should be recalled the more complex environment in which comorbidities influence the prevalence of hyperuricemia and gout and also complicate the treatment of both acute and chronic disease [1]. Serum urate (SUA) levels (Table 1) should be more commonly included in routine health assessment by primary care MDs involved in the management of diabetes, CKD, obesity, CAD and metabolic syndrome [2]. Similarly, rheumatologists need to be more cognizant of these potential problems when gout

How to handle diet modification in chronic hyperuricemia in the US and in Europe?

Numerous epidemiologic studies have outlined the effect of diet on SUA levels and on incident gout in populations [4] (Table 2). While classically low purine diets were favored in the past, their impalatability, complexity, and overall low effectiveness led to poor adherence. Newer information has allowed us to move towards more practical recommendations emphasizing the importance of weight control as the single most important factor. Purine laden and calorie dense foods such as red meat,

How to improve the treatment of acute gout?

Systematic literature review [5], [6] and recent Cochrane have reviewed the treatment of acute gout as well as prophylactic treatment to prevent “flares”. Whatever modality is chosen, treatment at the earliest possible time (meds “in the pocket”) leads to the best outcome. NSAIDs, oral colchicine, steroids (both intra-articular and systemic, 30–35 mg prednisone qd × 5days, as an example) may all be employed with the choice often dictated by custom in your practice environment (with NSAIDs more

How to optimize urate-lowering therapy?

Any patient with gout should be offered urate-lowering therapy (ULT), especially for those not reaching subsaturating serum urate levels with general measures (mainly lifestyle changes). Reaching a target SUA of <6 mg/dL (360 μmol/l) is desirable so as to reduce flare numbers induce tophi resolution, considering that the lowest serum urate levels would be desirable for the most severe patients [8]. Recent studies suggest gout is associated with increased cardiovascular events rate and mortality;

Will future or upcoming therapies improve management of gout?

Data on newer agents such as febuxostat approved in Europe last year, and recently approved in the US have been reviewed. Pivotal trials have demonstrated efficacy of this non-purine backbone-based (differing from allopurinol) inhibitor of xanthine oxidase and its possible advantage in those with renal impairment consequent to its primary elimination via hepatic metabolism. Trials of newly developed uricase attached to a PEG moiety were presented. This breaks down uric acid directly to

Conflicts of interest

David Zelman, John F. Scavulli and Fernando Perez-Ruiz have any conflicts of interest to declare.

Robert Terkeltaub: Consultant: Altus Pharmaceuticals; Ardea Biosciences, Inc.; BioCryst Pharmaceuticals Inc; EnzymeRx; Novartis Pharmaceuticals; Pfizer Inc; Regeneron Pharmaceuticals, Inc; Savient; Takeda Pharmaceuticals North America, Inc; UCB Pharma, Inc; URL Pharma.

Frédéric Lioté: Investigator: Abbott Laboratories; Centocor, Inc; Roche Pharmaceuticals; Serono, Inc; Wyeth Pharmaceuticals;

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