Korean J Med.  2009 Feb;76(2):151-162.

Updates in the management of gouty arthritis

Affiliations
  • 1Division of Rheumatology, Department of Internal Medicine, Kyung Hee University, School of Medicine, Seoul, Korea.

Abstract

Gout is the most common inflammatory arthritis in men over 40 years old and the prevalence is increasing. Asymptomatic hyperuricemia is predisposing condition of gout but the frequency of progression to acute gout is not high enough to need prophylactic treatment. In acute gout flare, first line therapy is non-steroid anti-inflammatory agents (NSAIDs) or corticosteroids, depending on comorbidities. Colchicine is now second line therapy. Urate lowering therapy for gout needs to be initiated when the second attack occurs in a year. Allopurinol, a xanthine oxidase inhibitor, has been the most widely used agent for the treatment of chronic gout. Now, febuxostat has emerged as a new xanthine oxidase inhibitor that is expected to be useful in patients with mildly decreased renal function. Uricosuric agents are alternative therapies for patients with preserved renal function and no history of nephrolithiasis. During urate lowering therapy, the dose should be titrated upward until the serum uric acid level is kept less than 6mg/dL. When initiating urate lowering therapy, concurrent prophylactic therapy with NSAIDs or low dose colchicine for more than six months is recommended for reducing flare-ups. In chronic gout treatment, dietary modification seems to have minimal effect, but alcohol drinking and weight control can be recommended.

Keyword

Gout; Gouty arthritis; Hyperuricemia; Treatment

MeSH Terms

Adrenal Cortex Hormones
Alcohol Drinking
Allopurinol
Anti-Inflammatory Agents
Anti-Inflammatory Agents, Non-Steroidal
Arthritis
Arthritis, Gouty
Colchicine
Comorbidity
Complementary Therapies
Food Habits
Gout
Humans
Hyperuricemia
Male
Nephrolithiasis
Prevalence
Thiazoles
Uric Acid
Uricosuric Agents
Xanthine Oxidase
Febuxostat
Adrenal Cortex Hormones
Allopurinol
Anti-Inflammatory Agents
Anti-Inflammatory Agents, Non-Steroidal
Colchicine
Thiazoles
Uric Acid
Uricosuric Agents
Xanthine Oxidase
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