Pharmacologic Management of Gout

Manouchkathe Cassagnol, PharmD, BCPS, CGP ; Maha Saad, PharmD, BCPS, CGP

Disclosures

US Pharmacist. 2013;38(3):22-26. 

In This Article

Abstract and Introduction

Abstract

Gout is a rheumatic disease that results from an excess body burden of uric acid, or hyperuricemia, which commonly manifests as recurrent episodes of acute joint pain and inflammation secondary to the deposition of monosodium urate crystals, or tophi, in the synovial fluid and lining. Hyperuricemia is caused by an increased production or a decreased excretion of uric acid, or both. Treatment of gout involves managing hyperuricemia with urate-lowering therapy (i.e., diet, lifestyle, pharmacologic agents) and of acute gouty arthritis with colchicine, nonsteroidal anti-inflammatory drugs, and/or corticosteroids. Pharmacists play an integral role in patient education and improving the care of patients with gout.

Introduction

Gout is a rheumatic disease that results from an excess body burden of uric acid, or hyperuricemia, which is variably defined as a serum urate concentration >6.8 or 7 mg/dL.[1] Gout commonly manifests as recurrent episodes of acute joint pain and inflammation secondary to the deposition of monosodium urate (MSU) crystals (tophi) in the synovial fluid and lining. Furthermore, renal involvement of gout due to MSU deposition in the urinary tract can result in urolithiasis and urinary obstruction.[2,3] Hyperuricemia is caused by an increased production or a decreased excretion of uric acid, or both. Underexcretion, the most common cause, is thought to account for 80% to 90% of hyperuricemia.[4] Although the risk of developing gout increases with the chronicity and increased concentrations of uric acid (>9 mg/dL), not all patients with hyperuricemia will develop gout.[2,3]

Gout is the most common rheumatic disease of adulthood, with a self-reported prevalence of more than 8 million cases in the United States, affecting 3.9% of adults, with a male-to-female ratio of 3:1.[5] However, at an older age the incidence of gout in women approaches the incidence in men.[6]

New gout guidelines from the American College of Rheumatology (ACR) have been recently published focusing on the use of urate-lowering therapy (ULT), analgesic and anti-inflammatory medications for the management of acute gouty arthritis, and drug prophylaxis of acute attacks (Table 1).[1,7]

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