An update on the pharmacotherapy of gout

Abstract

Introduction: Gout is a common form of acute inflammatory arthritis caused by the deposition of monosodium urate crystals within synovium of joints. This leads to severe pain, reducing quality of life for patients with this condition.

Areas covered: This review summarizes the treatment of both acute flares of gout and urate-lowering therapy based on guidance from various major international societies. We have also covered new emerging therapies that have not yet reached clinical practice.

Expert opinion: Standard pharmacotherapies for gout flares include the options of colchicine, NSAIDs and oral or intramuscular corticosteroids, with IL-1 inhibitors newly established as an option for flare refractory to standard therapies. Urate-lowering therapies aim to prevent gout flares, with an emphasis on treat-to-target strategy; the escalation of therapies until the target serum uric acid is reached. Initial treatments include allopurinol and febuxostat, with uricosuric agents, probenecid, sulfinpyrazone and benzbromarone, as adjuncts. There are also emerging therapies in development. However, there is increasing personalization of treatment, adjusting pharmacotherapy depending on comorbidities, such as chronic kidney disease and ischemic heart disease, as well as patient preference.

Keywords: Gout; IL-1 inhibitors; allopurinol; febuxostat; pegloticase; urate-lowering therapy; uricosurics.