Update on gout: new therapeutic strategies and options

@article{Terkeltaub2010UpdateOG,
  title={Update on gout: new therapeutic strategies and options},
  author={Robert Terkeltaub},
  journal={Nature Reviews Rheumatology},
  year={2010},
  volume={6},
  pages={30-38}
}
Gout, a disease recognized since antiquity, has increased in prevalence in recent years and the clinical profile of this disease has become increasingly complex, owing to large numbers of cases with iatrogenic factors, multiple comorbidities, advanced age, and hyperuricemia and arthritis refractory to treatment. In this Review, key advances in gout research made during the past decade are summarized. Revised strategies for safe and effective employment of dietary measures and pharmacologic… 
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TLDR
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References

SHOWING 1-10 OF 85 REFERENCES
Gout. Novel therapies for treatment of gout and hyperuricemia
TLDR
Effectively delivering improved management of hyperuricemia and gout will require a frame shift in practice patterns, including increased recognition of the implications of refractory disease and frequent noncompliance of patients with gout, and understanding the evidence basis for therapeutic targets in serum urate-lowering and goutsy inflammation.
The inflammatory process of gout and its treatment
TLDR
There are no placebo-controlled, randomized clinical studies for any of the therapies commonly used, although comparative studies have demonstrated that many nonsteroidal anti-inflammatory drugs are equivalent to indomethacin with respect to controlling acute gouty attacks.
Colchicine update: 2008.
Gout and hyperuricemia.
  • C. Agudelo
  • Medicine, Biology
    Current opinion in rheumatology
  • 1989
TLDR
The presentation of gout in patients with multiple comorbidities not only increases recognition of the toxicity of nonsteroidal anti-inflammatory drugs and colchicine, but often requires innovative approaches to its treatment.
Uricase and other novel agents for the management of patients with treatment-failure gout
TLDR
The clinical characteristics associated with treatment-failure gout are reviewed, potential therapies now in clinical development show promise, and recent data from clinical trials of febuxostat and uricase are discussed.
Colchicine for prophylaxis of acute flares when initiating allopurinol for chronic gouty arthritis.
TLDR
Colchicine prophylaxis during initiation of allopurinol for chronic gouty arthritis reduces the frequency and severity of acute flares, and reduces the likelihood of recurrent flares.
Treatment-failure gout: a moving target.
TLDR
Gout remains a form of arthritis that is very poorly managed by both primary care physicians and rheumatologists and concerns about toxicity have dampened enthusiasm for the use of probenecid, the only remaining uricosuric agent currently available in the US.
A critical reappraisal of allopurinol dosing, safety, and efficacy for hyperuricemia in gout
TLDR
The emergence of novel urate-lowering therapeutic options, such as febuxostat and uricase, makes timely this review of current allopurinol dosing guidelines, safety, and efficacy in gout hyperuricemia therapy, including patients with chronic kidney disease.
A pilot study of IL-1 inhibition by anakinra in acute gout
TLDR
IL-1 blockade appears to be an effective therapy for acute gouty arthritis, according to a pilot, open-labeled study in patients with gout who could not tolerate or had failed standard antiinflammatory therapies.
Mechanisms of inflammation in gout.
TLDR
This review article outlines recent advances in the understanding of the mechanisms of inflammation in gout and proposes a unifying model of gout involving the differential role of mononuclear phagocytes in the regulation of the inflammatory response to MSU crystals.
...
...