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GOUT IN 2018

Prevention and treatment of gout

Nature Reviews Rheumatology volume 15, pages 68–70 (2019)Cite this article

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In 2018, advances in the treatment of gout flares came in the form of a new nurse-led management approach to serum urate lowering and evidence that allopurinol might have a better cardiovascular safety profile than febuxostat. However, are IL-1β blockers such as canakinumab the future of care for patients with gout?

Key advances

  • Nurse-led care can improve outcomes for people with gout and is cost effective2.

  • Febuxostat should be used with caution in people with gout and established cardiovascular disease3.

  • The IL-1β inhibitor canakinumab prevents incident gout without altering serum urate levels4.

Gout remains a common and challenging management problem. Despite advances in understanding the pathophysiology of gout and availability of effective urate-lowering therapies, management of gout continues to be suboptimal. Current healthcare systems, the belief that only gout flares require treatment and lack of understanding about the role of urate-lowering therapy by both health-care providers and patients all contribute to low rates of urate-lowering therapy initiation and continuation, and consequently, poor outcomes for people with gout1. In 2018, three papers2,3,4 advanced our understanding of the best ways to manage gout.

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References

  1. Rai, S. et al. Key barriers to gout care: a systematic review and thematic synthesis of qualitative studies. Rheumatology 57, 1282–1292 (2018).

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  2. Doherty, M. et al. Efficacy and cost-effectiveness of nurse-led care involving education and engagement of patients and a treat-to-target urate-lowering strategy versus usual care for gout: a randomised controlled trial. Lancet 392, 1403–1412 (2018).

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  3. White, W. et al. Cardiovascular safety of febuxostat or allopurinol in patients with gout. N. Engl. J. Med. 378, 1200–1210 (2018).

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  4. Solomon, D. et al. Relationship of interleukin-1β blockade with incident gout and serum uric acid levels: exploratory analysis of a randomized controlled trial. Ann. Intern. Med. 169, 535–542 (2018).

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  9. Ridker, P. et al. Antiinflammatory therapy with canakinumab for atherosclerotic disease. N. Engl. J. Med. 377, 1119–1131 (2017).

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  10. Stamp, L. et al. Serum urate as surrogate endpoint for flares in people with gout: a systematic review and meta-regression analysis. Semin. Arthritis Rheum. 48, 293–301 (2018).

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Author information

Authors and Affiliations

  1. Department of Medicine, University of Otago, Christchurch, New Zealand

    Lisa K Stamp

  2. Department of Medicine, University of Auckland, Auckland, New Zealand

    Nicola Dalbeth

Authors
  1. Lisa K Stamp
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  2. Nicola Dalbeth
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Corresponding author

Correspondence to Lisa K Stamp.

Ethics declarations

Competing interests

L. S. declares that she has received speaker fees from Amgen and is currently a co-investigator on a clinical trial (ACTRN12615001219572) of intensive urate-lowering therapy (funded by the Health Research Council of New Zealand). N.D. declares that she has received speaking fees from AbbVie, Horizon, Janssen and Pfizer, consulting fees from Hengrui, Horizon and Kowa, research funding from Amgen and AstraZeneca and is currently principal investigator on a clinical trial (ACTRN12615001219572) of intensive urate-lowering therapy (funded by the Health Research Council of New Zealand). N.D. also declares that within the past 5 years she has been principal investigator on a clinical trial of febuxostat (NCT01078389) in early gout and has received consulting or speaking fees from Menarini, Takeda and Teijin.

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Stamp, L.K., Dalbeth, N. Prevention and treatment of gout. Nat Rev Rheumatol 15, 68–70 (2019). https://doi.org/10.1038/s41584-018-0149-7

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