Update on gout: new therapeutic strategies and options

  title={Update on gout: new therapeutic strategies and options},
  author={Robert Terkeltaub},
  journal={Nature Reviews Rheumatology},
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… 
Recent advances in management of gout.
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  • Medicine
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A new era has thus begun in the field of gout with introduction of new treatments such as interleukin-1 antagonists for management of acute gout, and febuxostat and pegloticase for chronic gout.
Gout: current insights and future perspectives.
Pegloticase: A new biologic for treating advanced gout
As a new class of biologic agent offering documented and dramatic effects on lowering serum uric acid and remarkably rapid outcomes in resolving tophi, pegloticase can provide safe and effective management of hyperuricemia and gout for many patients, particularly those who have a high disease burden.
Febuxostat: drug review and update
Febuxostat is effective in the treatment of mild-to-moderate renal/hepatic impairment with dramatic effects on the serum urate level and can be used safely in patients with hypersensitivity reactions to allopurinol.
Recent Progress in the Management of Gouty Arthritis and Hyperuricemia
A practical review of the currently recommended practice of care and also to introduce some recently approved drugs for the treatment of gout.
Managing Your Patient with Gout: A Review of Treatment Options
Patient education, especially counseling on risk factors and contributors to hyperuricemia and gout, can improve the likelihood of successful therapy for this often suboptimally managed disease.
Gouty arthritis: an approach for general practice
Treating to target: a serum uric acid level < 0.35mmol/l, prevents crystal deposition in joints and soft tissues, thereby preventing acute attacks and ongoing inflammation, as well as decreasing the size and number of tophi.
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Febuxostat's overall efficacy and safety profile is comparable and, in certain subsets such as gout patients with mild and moderate renal insufficiency, is superior to allopurinol.


Gout. Novel therapies for treatment of gout and hyperuricemia
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
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.
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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
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.
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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.
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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.
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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.
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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.
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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.