Change gout: how to deal with this “silently-developing killer” in everyday clinical practice

Abstract

Background: Despite being regarded as an easily-treatable disease, gout diagnosis and management can be challenging.

Review: This review discusses current issues in gout management and proposes some potential solutions. Gout diagnosis should be reached as early as possible and often requires specific tests, such as synovial fluid analysis or imaging techniques that are not available in most centers, leaving healthcare professionals to rely only on clinical presentations and their experience. In addition, gout management requires the evaluation of multiple aspects, such as monitoring of serum uric acid (sUA) level (which should be reduced to <6 mg/dL) to ensure adherence and efficacy of treatment, evaluation of patient’s risk profile and comorbidities, and continuous assessments to manage clinical manifestations. An important premise in gout management is non-pharmacological intervention; however, pharmacological urate-lowering therapy is crucial for an optimal control of the disease. Available options include xanthine-oxidase inhibitors (XOI), targeting uric acid overproduction, and uricosuric agents which target the predominant cause of hyperuricemia (under-excretion). Among these, lesinurad is the novel uricosuric agent to be used in combination with XOI in patients with gout not adequately controlled with XOI alone, which can further contribute to the control of hyperuricemia in gout.

Conclusions: Multidisciplinary management is crucial for the diagnosis and treatment of gout, in order to ensure treatment continuity and improve management. This review, therefore, advises that educational activities for General Practitioners and specialists should be implemented to help raise awareness on gout diagnosis, monitoring, and treatment.

Keywords:

• Gout/pathology
• gout/drug therapy
• gout/diagnosis
• hyperuricemia
• xanthine oxidase/antagonists & inhibitors
• uricosuric agents

Transparency

Declaration of funding

Medical writing and publication costs was supported by Grunenthal, the manufacturer of lesinurad.

Declaration of financial/other interests

The authors have disclosed that they have no significant relationships with or financial interests in any commercial companies related to this study or article. Peer reviewers on this manuscript have received an honorarium from CMRO for their review work, but have no other relevant financial relationships to disclose.

Acknowledgments

Medical writing was performed by Luca Giacomelli, PhD and Ambra Corti (private practice, Milan, Italy). This paper is dedicated to the memory of Dr Augusto Genderini, who suddenly passed away just before the submission of the manuscript. The authors and all at the Working Group are honored to have worked with him.