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Management of complex gout in clinical practice: Update on therapeutic approaches.
Best Pract Res Clin Rheumatol 2018; 32(6):813-834BP

Abstract

Increasing therapeutic options are available for gout management. Anti-inflammatory agents are used in the acute management of gout flares, and interleukin-1 inhibitors are effective for those unable to take conventional anti-inflammatory treatments. Lowering of serum urate remains the cornerstone of effective long-term management. Allopurinol is the first-line urate-lowering therapy, and a gradual dose-escalation strategy to serum urate target is recommended. Febuxostat and lesinurad have been approved more recently. In a large cardiovascular outcomes trial, higher all-cause and cardiovascular mortality was observed with febuxostat than with allopurinol. Lesinurad should be co-prescribed with a xanthine oxidase inhibitor, and close monitoring of kidney function is required. Evidence for non-pharmacological management is limited, but personalised lifestyle modification may reduce associated cardiovascular risk. In this review, we discuss current principles in the gout management paradigm, consider strategies for managing complex, clinical scenarios, and review emerging therapies.

Authors+Show Affiliations

Department of Medicine, University of Auckland, Auckland, New Zealand.Department of Medicine, University of Auckland, Auckland, New Zealand. Electronic address: n.dalbeth@auckland.ac.nz.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't
Review

Language

eng

PubMed ID

31427057

Citation

Narang, Ravi K., and Nicola Dalbeth. "Management of Complex Gout in Clinical Practice: Update On Therapeutic Approaches." Best Practice & Research. Clinical Rheumatology, vol. 32, no. 6, 2018, pp. 813-834.
Narang RK, Dalbeth N. Management of complex gout in clinical practice: Update on therapeutic approaches. Best Pract Res Clin Rheumatol. 2018;32(6):813-834.
Narang, R. K., & Dalbeth, N. (2018). Management of complex gout in clinical practice: Update on therapeutic approaches. Best Practice & Research. Clinical Rheumatology, 32(6), pp. 813-834. doi:10.1016/j.berh.2019.03.010.
Narang RK, Dalbeth N. Management of Complex Gout in Clinical Practice: Update On Therapeutic Approaches. Best Pract Res Clin Rheumatol. 2018;32(6):813-834. PubMed PMID: 31427057.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Management of complex gout in clinical practice: Update on therapeutic approaches. AU - Narang,Ravi K, AU - Dalbeth,Nicola, Y1 - 2019/04/12/ PY - 2019/8/21/entrez PY - 2019/8/21/pubmed PY - 2019/11/13/medline KW - Allopurinol KW - Colchicine KW - Febuxostat KW - Gout KW - Urate SP - 813 EP - 834 JF - Best practice & research. Clinical rheumatology JO - Best Pract Res Clin Rheumatol VL - 32 IS - 6 N2 - Increasing therapeutic options are available for gout management. Anti-inflammatory agents are used in the acute management of gout flares, and interleukin-1 inhibitors are effective for those unable to take conventional anti-inflammatory treatments. Lowering of serum urate remains the cornerstone of effective long-term management. Allopurinol is the first-line urate-lowering therapy, and a gradual dose-escalation strategy to serum urate target is recommended. Febuxostat and lesinurad have been approved more recently. In a large cardiovascular outcomes trial, higher all-cause and cardiovascular mortality was observed with febuxostat than with allopurinol. Lesinurad should be co-prescribed with a xanthine oxidase inhibitor, and close monitoring of kidney function is required. Evidence for non-pharmacological management is limited, but personalised lifestyle modification may reduce associated cardiovascular risk. In this review, we discuss current principles in the gout management paradigm, consider strategies for managing complex, clinical scenarios, and review emerging therapies. SN - 1532-1770 UR - https://www.unboundmedicine.com/medline/citation/31427057/Management_of_complex_gout_in_clinical_practice:_Update_on_therapeutic_approaches L2 - https://linkinghub.elsevier.com/retrieve/pii/S1521-6942(19)30045-2 DB - PRIME DP - Unbound Medicine ER -