Article

Treating to target: A strategy to cure gout

Rheumatology Division, Hospital de Cruces, 48600 Baracaldo, Vizcaya, Spain.
Rheumatology (Oxford, England) (Impact Factor: 4.48). 05/2009; 48 Suppl 2(2):ii9-ii14. DOI: 10.1093/rheumatology/kep087
Source: PubMed

ABSTRACT

Acute gout attacks and the long-term complications of gout are associated with the deposition of monosodium urate (MSU) monohydrate crystals in the joints and soft tissues, causing acute and chronic inflammation. The aim of long-term treatment is to reduce the serum urate (sUA) level to 6 mg/dl (< or =360 micromol/l), below the saturation point of MSU, so that new crystals cannot form and existing crystals are dissolved. Serial joint aspiration studies confirmed the disappearance of crystals with effective urate-lowering therapy. There is good evidence that achieving sUA <6 mg/dl (360 micromol/l) results in freedom from acute gout attacks, and shrinkage and eventual disappearance of tophi. Gout patients must be informed about their diagnosis and educated about gout management including the importance of compliance with long-term treatment. Patients starting urate-lowering therapy need to understand the importance of prophylactic therapy with colchicine or NSAIDs to reduce the risk of 'mobilization flares' in the first few months. In the long term, reduction in the sUA below the target level will result in gout being effectively cured.

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Available from: Fernando Perez-Ruiz, Dec 24, 2015
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    • "[28] Lifestyle modification is also recommended for gout management—in particular, weight control, regular exercise and a reduction in the consumption of red meat, alcohol and high fructose corn syrup, which can elevate sUA levels via metabolism .[26] [29] [30] While beneficial for general health, these lifestyle measures have relatively modest effects on sUA burden and gout symptoms, and few patients reach management targets by these measures alone.[3] [24] Despite the availability of management guidelines, there is continuing evidence that gout is not being managed effectively in a substantial proportion of patients. "
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    ABSTRACT: Objectives: Gout is a chronic, extremely painful disease that is potentially curable when treated effectively. Unfortunately approximately one-half of patients with gout are inadequately controlled. Methods: We surveyed 315 primary care physicians in the United States and Europe to investigate current practice in the real world, as distinct from recommendations in guidelines. Results: Our survey on 1657 patients found that regular testing of serum uric acid, in conformity with the guidelines, was conducted by approximately 50% of physicians. Advice to patients on diet and lifestyle was less well implemented, and identification of overweight/obese patients was inconsistent. Conclusion: Improvements in practice by physicians would include comprehensive assessment of the patient, adoption of regular monitoring during treatment, and the provision of patient education on adherence and lifestyle.
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    • "The prevalence of gout has increased over the past few decades to 3.9% of US adults (8.3 million individuals) [1], which is further complicated by a high level of cardiovascular, metabolic, and renal comorbidities [2]. The pathogenesis of gout is well understood; high levels of circulating serum uric acid (SUA) lead to the acute and chronic manifestations of gout via the deposition of monosodium urate crystals in the joints and the soft tissues [3]. Reducing SUA levels effectively " cures " the disease [4], and guidelines including the American College of Rheumatology [5] and the European League Against Rheumatism [6] recommend lowering SUA levels to target levels (o 6 mg/dL or o 5 mg/dL), as well as reducing recurrent attacks, destructive arthropathy, renal disease, and comorbidity. "
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    Full-text · Article · Feb 2015 · Seminars in Arthritis and Rheumatism
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    • "In the case of gout, medical intervention is indicated in order to prevent progression and to eliminate any tophi [4]. A sustained reduction of serum uric acid levels is "
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