Optimizing current treatment of gout

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Key Points

  • Many established treatments are already available for managing gout effectively

  • Lowering serum uric acid to a target level below the saturation point for urate can effectively 'cure' gout

  • Health professionals need to be aware of current best practice for the management of gout

  • Patient education and discussion of illness perceptions is key to addressing patient-specific risk factors and ensuring adherence to an individualized management plan

  • Shared decision-making between a fully informed patient and a health practitioner, whether a doctor, nurse or pharmacist, can greatly increase the likelihood of a 'cure' and lead to improvements in patient outcomes

Abstract

Gout is the most common inflammatory arthritis worldwide. Although effective treatments exist to eliminate sodium urate crystals and to 'cure' the disease, the management of gout is often suboptimal. This article reviews available treatments, recommended best practice and barriers to effective care, and how these barriers might be overcome. To optimize the management of gout, health professionals need to know not only how to treat acute attacks but also how to up-titrate urate-lowering therapy against a specific target level of serum uric acid that is below the saturation point for crystal formation. Current perspectives are changing towards much earlier use of urate-lowering therapy, even at the time of first diagnosis of gout. Holistic assessment and patient education are essential to address patient-specific risk factors and ensuring adherence to individualized therapy. Shared decision-making between a fully informed patient and practitioner greatly increases the likelihood of curing gout.

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Figure 1: Metabolism of uric acid and risk factors for gout.
Figure 2: Metabolism and mechanisms of action of colchicine.
Figure 3: Management of acute gout attack.
Figure 4: “Punch cures the gout, the colic, and the 'tisick” (anonymous).
Figure 5: Mechanism of action of uricosuric drugs at the proximal renal tubule.
Figure 6: Graph representing clearance induction and maintenance phases of therapy for gout.
Figure 7: A full and holistic assessment followed by individualized patient education is core to the management of people with gout.

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All authors made substantial contributions to discussions of content, writing, and reviewing/editing the manuscript before submission.

Correspondence to Michael Doherty.

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Competing interests

M.D. has received honoraria for being a member of ad hoc Advisory Boards for Ardea Biosciences, Menarini, Novartis and Savient. M.H. and F.R. declare no competing interests.

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Rees, F., Hui, M. & Doherty, M. Optimizing current treatment of gout. Nat Rev Rheumatol 10, 271–283 (2014) doi:10.1038/nrrheum.2014.32

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