Materiały źródłowe

• #1 Gout – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/gout/diagnosis-treatment/drc-20372903

  Gout medications are available in two types and focus on two different problems. The first type helps reduce the inflammation and pain associated with gout attacks. The second type works to prevent gout complications by lowering the amount of uric acid in your blood. […] Drugs used to treat gout flares and prevent future attacks include: […] Your doctor may recommend medication to reduce your risk of gout-related complications. If you already have evidence of damage from gout on joint X-rays, or you have tophi, chronic kidney disease or kidney stones, medications to lower your body’s level of uric acid may be recommended. […] Medications that block uric acid production. Drugs such as allopurinol (Aloprim, Lopurin, Zyloprim) and febuxostat (Uloric) help limit the amount of uric acid your body makes. […] Medications that improve uric acid removal. Drugs such as probenecid (Probalan) help improve your kidneys’ ability to remove uric acid from your body.

• #2 Gout: Symptoms, Treatment & Prevention

  https://my.clevelandclinic.org/health/diseases/4755-gout

  Gout is a painful form of arthritis. Treatment is usually a combination of symptom management and changing your diet. […] A healthcare provider will suggest medications and changes to your diet that will lower your uric acid levels and minimize how often you experience gout attacks in the future. […] Treating gout is usually a combination of managing your symptoms during a flare and reducing how often you consume high-purine foods and drinks. […] Your healthcare provider might suggest medications to help manage your symptoms, including: NSAIDs, colchicine, corticosteroids. […] Your provider might prescribe medications to help lower your uric acid levels. The most common medications that lower uric acid include: Allopurinol, Febuxostat, Pegloticase, Probenecid. […] Your healthcare provider may suggest you follow a low-purine diet. A low-purine diet encourages you to consume fewer foods and drinks with high purine content. This will help reduce uric acid in your body.

• #3 Gout Treatment : Medications and Lifestyle Adjustments to Lower Uric Acid

  https://www.hopkinsarthritis.org/arthritis-info/gout/gout-treatment/

  The goal of treatment during an acute gout attack is suppression of inflammation and control of pain. Treatment of pain and inflammation can be achieved with NSAIDs, colchicine, or corticosteroids (systemic or intra-articular). Patients who have multiple episodes of acute gout attacks per year or who have tophi on exam are candidates for uric acid lowering therapy. Use of uric acid lowering agents will reduce the frequency of gout attacks and over time, reduce tophi formation, and diminish the risk of joint destruction. All patients should be encouraged to modify their lifestyle including limiting alcohol intake, encouraging weight loss where appropriate and decreasing food rich in purines. Probenecid may be given to patients with decreased clearance of uric acid by the kidney and normal renal function. Allopurinol is a well tolerated, inexpensive, and commonly used uric acid lowering agent. Febuxostat is a new xanthine oxidase inhibitor, approved for the treatment of hyperuricemia in gout. Pegloticase is a porcine uricase which was approved by the FDA in September 2010 for the treatment of gout in patients who have failed conventional therapy. Avoidance of purine rich foods and alcohol may help lower uric acid levels and prevent significant fluctuations in serum uric acid that may precipitate acute attacks. […] Eating a healthy balanced diet of low-fat proteins, low-fat dairy and vegetables will help maintain a healthy weight which is beneficial for the prevention of gout attacks as well.

• #4 Gout: Treatment of flares – UpToDate

  https://www.uptodate.com/contents/treatment-of-gout-flares

  Initiate therapy quickly — Once the diagnosis has been established and infection seems less likely, treatment should start as soon as possible, preferably within hours of symptom onset. More rapid and complete resolution of symptoms occurs the earlier that treatment is introduced. We encourage patients with established gout to maintain a supply of gout flare medication at home to allow initiation of treatment at the first sign of flare. […] Continue or initiate chronic therapies for gout — For patients who are taking urate-lowering therapy (eg, allopurinol, febuxostat, probenecid), we continue these medications without interruption during gout flares. There is no benefit to temporary discontinuation of urate-lowering therapy. […] Selection of agent — Patients with gout flares typically require initiation of a systemic antiinflammatory agent, such as a glucocorticoid, nonsteroidal antiinflammatory drug (NSAID), colchicine, or interleukin 1 (IL-1) inhibitor. These are all effective treatment options and should be started as soon as possible after the onset of the gout flare.

• #5 Gout: Treatment of flares – UpToDate

  https://www.uptodate.com/contents/gout-treatment-of-flares/print

  Initiate therapy quickly — Once the diagnosis has been established and infection seems less likely, treatment should start as soon as possible, preferably within hours of symptom onset. More rapid and complete resolution of symptoms occurs the earlier that treatment is introduced. We encourage patients with established gout to maintain a supply of gout flare medication at home to allow initiation of treatment at the first sign of flare. […] Continue or initiate chronic therapies for gout — For patients who are taking urate-lowering therapy (eg, allopurinol, febuxostat, probenecid), we continue these medications without interruption during gout flares. There is no benefit to temporary discontinuation of urate-lowering therapy. […] Nonpharmacologic strategies can also reduce the risk of future gout flares. Some strategies can be implemented relatively quickly and may be done while patients are being treated for a gout flare (eg, adjustment of medications that affect urate balance) while others require more time (eg, management of related comorbid conditions, dietary modification).

• #6 Treatments for Gout | Arthritis Foundation

  https://www.arthritis.org/health-wellness/treatment/treatment-plan/disease-management/treatments-for-gout

  For Relief of Acute Attacks: NSAIDs. In low doses, nonsteroidal anti-inflammatory drugs (NSAIDs) can be effective at relieving pain. At higher prescription doses they can also help control inflammation. It’s important to note that if you have kidney disease along with gout, you should not take NSAIDs. Analgesics. For less severe gout pain, over-the-counter acetaminophen (Tylenol) may be sufficient. For severe pain, speak with your doctor about other pain relievers. Corticosteroids. Similar to the cortisone your body makes naturally, corticosteroid medications are potent anti-inflammatories. Your doctor may prescribe oral or injected corticosteroids to quickly reduce inflammation during a gout attack. Colchicine. This oral anti-inflammatory is commonly prescribed to both treat acute attacks and prevent further attacks.

• #7 Diagnosis, Treatment, and Prevention of Gout | AAFP

  https://www.aafp.org/pubs/afp/issues/2014/1215/p831.html

  Gout is characterized by painful joint inflammation, most commonly in the first metatarsophalangeal joint, resulting from precipitation of monosodium urate crystals in a joint space. […] Acute gout may be treated with nonsteroidal anti-inflammatory drugs, corticosteroids, or colchicine. […] Allopurinol and febuxostat are first-line medications for the prevention of recurrent gout, and colchicine and/or probenecid are reserved for patients who cannot tolerate first-line agents or in whom first-line agents are ineffective. […] Patients receiving urate-lowering medications should be treated concurrently with nonsteroidal anti-inflammatory drugs, colchicine, or low-dose corticosteroids to prevent flares. […] Treatment should continue for at least three months after uric acid levels fall below the target goal in those without tophi, and for six months in those with a history of tophi.

• #8 Gout: Treatment of flares – UpToDate

  https://www.uptodate.com/contents/gout-treatment-of-flares/print

  Patients who are initiating urate-lowering pharmacotherapy around the time of a gout flare may benefit from a prolonged course of antiinflammatory therapy for prophylaxis of flares; colchicine and NSAIDs are used more commonly for this indication than glucocorticoids. […] Colchicine […] Colchicine is contraindicated in the presence of any degree of kidney or hepatic impairment in patients who are actively using or have recently taken a P-glycoprotein (P-gp) inhibitor or an agent that strongly reduces availability of the cytochrome P450 system component CYP3A4. […] We only use oral formulations of colchicine. Depending on the size of colchicine tablet available, we use an initial dose of 1 to 1.2 mg, followed one hour later by another 0.5 to 0.6 mg, for a total dose on the first day of therapy of 1.5 to 1.8 mg. Subsequently, the colchicine dose should be reduced to 0.5 to 0.6 mg twice daily until 48 hours after resolution of the flare.

• #9 Gout: Treatment of flares – UpToDate

  https://www.uptodate.com/contents/gout-treatment-of-flares/print

  Dosing, duration, and efficacy of therapies […] Systemic glucocorticoids […] In general, we avoid using systemic glucocorticoids in patients with concurrent infection, brittle diabetes, recent surgery with an unhealed wound, and/or history of glucocorticoid allergy or intolerance. More information on contraindications to and adverse effects associated with glucocorticoids is provided elsewhere. […] We typically use oral glucocorticoids unless patients are unable to take them, in which case we offer intravenous or intramuscular formulations depending on the care setting. […] When using oral glucocorticoids, we give prednisone 40 mg daily (or its equivalent) until the flare resolves, followed by a taper. […] The duration of therapy for a gout flare should be tailored to each patient’s needs and may range from only a few days to several weeks (particularly for patients with severe or polyarticular flares). Many patients who are treated promptly (ie, within 12 to 36 hours of symptom onset) require treatment for no more than 5 to 10 days; however, those who have severe flares or who experience a delay in initiating treatment may need extended treatment for several weeks.

• #10 Gout: Treatment of flares – UpToDate

  https://www.uptodate.com/contents/gout-treatment-of-flares/print

  Selection of agent — Patients with gout flares typically require initiation of a systemic antiinflammatory agent, such as a glucocorticoid, nonsteroidal antiinflammatory drug (NSAID), colchicine, or interleukin 1 (IL-1) inhibitor. These are all effective treatment options and should be started as soon as possible after the onset of the gout flare. […] The choice of antiinflammatory agent will largely depend on whether there is a factor that strongly influences the risks of adverse effects related to certain therapies (eg, concern for septic arthritis as a concomitant or alternative diagnosis, comorbid conditions such as kidney disease). Other factors include the provider’s familiarity with these agents, cost considerations, and the patient’s familiarity, access, and prior successful use of a medication.

• #11 Treatment of Gout in Patients with CrCl ≤30 mL/min and/or on Hemodialysis: A Review

  https://www.mdpi.com/2674-0621/4/1/5

  Gout is highly prevalent in patients with chronic kidney disease (CKD) and end-stage renal disease (ESRD), owing to impaired uric acid excretion. However, treating gout in this population is challenging due to concerns about medication safety and efficacy with reduced kidney function. This review examines the evidence of various pharmacologic and non-pharmacologic approaches to managing gout in CKD/ESRD. For acute gout flares, there is insufficient evidence to guide optimal dosing of NSAIDs, colchicine, and corticosteroids in advanced CKD. The risks generally outweigh the benefits of NSAIDs and colchicine. Corticosteroids appear safer but require individual risk-benefit assessments. Interleukin-1 inhibitors show promise, but larger studies are needed. For long-term urate lowering, xanthine oxidase inhibitors like allopurinol and febuxostat are preferred over probenecid and other uricosurics. However, studies specifically evaluating urate-lowering therapies in CKD are scarce, resulting in conflicting expert guidelines. Starting with low allopurinol doses and gradual titration can mitigate the risks. Higher allopurinol doses may be needed to reach urate targets in some CKD patients. Febuxostat’s safety in advanced CKD remains debated. Optimal gout management in dialysis patients is also unclear, including when to continue urate-lowering therapy. Overall, gout is often suboptimally treated in CKD/ESRD, highlighting the need for more research to guide therapy in this population. Improving management can significantly reduce the burden of these comorbid diseases.

• #12 Management of Acute and Chronic Gout – The Nephrology Perspective

  https://openurologyandnephrologyjournal.com/VOLUME/9/PAGE/7/FULLTEXT/

  Gouty arthritis patients have multiple co-morbidities. For example, review of the Veterans Affairs medical database showed that 47% had chronic kidney disease. The National Health and Nutrition Examination Survey revealed that 9% of patients with gouty arthritis had renal impairment. […] EULAR (European League Against Rheumatism) guide-lines and recommendations for NSAIDs are as follows for the different stages of chronic kidney disease: NSAIDs are relatively contraindicated in CKD stage I-II. If they are used, the suggested dose is indomethacin 50 mg three times a day or an equivalent NSAID until pain becomes tolerable. It is not to be used for more than a week, and the dose should be rapidly reduced to zero. Caution is advised in CKD stage III. […] In patients with CKD, low dose colchicine given within 36 hours of onset of symptoms is equivalent to high dose colchicine. It is usually given orally in doses of 1.2 mg followed by an additional dose of 0.6 mg in 1 hr. This treatment should be repeated no more than once every 2 weeks.

• #13 Treatments for Gout | Arthritis Foundation

  https://www.arthritis.org/health-wellness/treatment/treatment-plan/disease-management/treatments-for-gout

  Treatments for Gout […] Learn what medical treatments to expect when you’ve been diagnosed with gout, and what you can do for yourself. […] Controlling gout may involve medication, physical therapy, a healthy diet and a healthy lifestyle. Work closely with your doctor and health care team to create a treatment plan that works well for you. […] The goal of treatment for gout is to relieve pain and inflammation of acute attacks, reduce uric acid level to 6 milligrams per deciliter (6 mg/dL) or lower to reduce further attacks, prevent joint damage, and preserve function and help you continue normal daily activities. […] Medications are an essential part of treatment for many people with gout. Medications for gout have two purposes: to relieve pain and inflammation of acute attacks and to control uric acid levels to prevent further attacks. Your treatment plan will likely include some of the following:

• #14 Gout and Pseudogout Treatment & Management: Approach Considerations, Treatment of Acute Attacks, Treatment of Chronic Gout

  https://emedicine.medscape.com/article/329958-treatment

  The treatment targets are as follows: Serum uric acid levels reduced below 6 mg/dL and maintained there, Tophi reduced in number or size, Pain reduction, Absence of attacks. […] Treatment of the acute phase of pseudogout is identical to that of acute gout. […] Acute treatment of proven crystal-induced arthritis is directed at relief of the pain and inflammation. […] Therapy to control the underlying hyperuricemia generally is contraindicated until the acute attack is controlled. […] If attacks are recurrent or evidence of tophaceous or kidney disease is present, therapy for control of hyperuricemia is indicated. […] NSAIDs are the drugs of choice in most patients with acute gout who do not have underlying health problems. […] Colchicine should generally be avoided if the glomerular filtration rate (GFR) is lower than 10 mL/min.

• #15 Diagnosis, Treatment, and Prevention of Gout | AAFP

  https://www.aafp.org/pubs/afp/issues/2014/1215/p831.html

  Allopurinol, a xanthine oxidase inhibitor, is a first-line agent to prevent recurrent gout. […] Febuxostat (Uloric) is a xanthine oxidase inhibitor that was approved by the FDA in 2009. […] Febuxostat is considered a first-line agent to prevent recurrent gout, but it is considerably more expensive than allopurinol. […] Probenecid increases urinary excretion of uric acid and is typically used as a second-line treatment because of numerous drug interactions. […] Pegloticase (Krystexxa) is an intravenous uricase approved by the FDA in 2010.

• #16 Treatment of hyperuricaemia and gout

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4954312/

  First-line drugs for treatment of acute gout are a quick-acting oral non-steroidal anti-inflammatory drug (NSAID) or low-dose colchicine (0.5 mg twice to four times daily) […] If NSAIDs and colchicine are ineffective or poorly tolerated, corticosteroids are an effective treatment by intra-articular, intramuscular or oral routes […] Allopurinol should be started at a low dose, for example 50-100 mg daily, and increased slowly with the aim of reducing serum urate to below 360 mol/l […] Options for urate-lowering therapy in patients intolerant of allopurinol include febuxostat, uricosuric drugs or allopurinol desensitisation […] Treatment of acute gout aims to provide rapid relief of pain and inflammation […] The single most effective treatment for acute gout is combined joint aspiration (immediately reducing intra-articular pressure and severe pain) and injection of intra-articular corticosteroid

• #17 Treatments for Gout | Arthritis Foundation

  https://www.arthritis.org/health-wellness/treatment/treatment-plan/disease-management/treatments-for-gout

  For Lowering Uric Acid: The following drugs reduce levels of uric acid by decreasing its production or increasing its elimination through the kidneys. Allopurinol (Zyloprim). A member of a drug class called xanthine oxidase inhibitors (XOIs), this medication, taken orally each day, reduces the body’s production of uric acid. Febuxostat (Uloric). If you are unable to take allopurinol, your doctor may prescribe febuxostat, another XOI. (Febuxostat carries a higher risk of heart disease than allopurinol.) Taken by mouth daily, febuxostat reduces uric acid production. Pegloticase (Krystexxa). One of the newer treatments for gout, pegloticase is reserved for those whose gout hasn’t responded to other treatments. This biologic agent, administered every two weeks by intravenous (IV) infusion, converts uric acid into allantoin, a chemical compound which is easily eliminated by the body. Anakinra (Kineret) and canakinumab (Ilaris). Anakinra and canakinumab are members of a class of biologic drugs called interleukin-1 (IL-1) inhibitors. Reserved for patients for whom other medications are not effective or well tolerated, they are given by injection.

• #18 Urate-Lowering Therapy for the Prevention and Treatment of Gout Flare

  https://www.uspharmacist.com/article/uratelowering-therapy-for-the-prevention-and-treatment-of-gout-flare

  Xanthene oxidase is an enzyme that converts hypoxanthine into xanthene and then xanthene into uric acid during purine metabolism. Suppression of this enzyme is the target of the XOIs and is responsible for reducing uric acid production. […] Allopurinol and febuxostat are currently the only two FDA-approved XOIs. […] Probenecid is considered a first-line uricosuric agent. […] Pegloticase is recommended for use in patients with clinically severe crystal-proven gout that has failed to reach the target uric acid goal at the maximum dose of XOI and uricosuric agents, including a combination of the drugs. […] Concurrent anti-inflammatory prophylaxis is recommended for all patients during the initiation of ULT to lower the risk of ULT-induced gout flare. […] Dietary modification is typically the initial treatment for patients with gout. For patients who do not reach target serum uric acid goals with diet changes alone, pharmacologic therapy is required to reduce the production or increase the excretion of serum uric acid. There are first-, second-, and third-line therapies available to reach the desired serum uric acid levels. Rapidly lowering serum urate may initiate episodes of acute gout flare. ULT should be titrated and accompanied by gout flare prophylaxis upon initiation.

• #19 A Different Kind of Uric Acid Treatment | KRYSTEXXA® (pegloticase)

  https://www.krystexxa.com/gout-treatment

  KRYSTEXXA with methotrexate reduces the risk of infusion reactions. […] Lowering your uric acid level enough to dissolve gout buildup is the key to reducing the impact of out-of-control gout. […] Clinical studies revealed that in about 6 months, KRYSTEXXA with methotrexate can remove years of uric acid crystal buildup from your joints. […] If you and your doctor decide methotrexate is not right for you, KRYSTEXXA is effective when taken alone. […] Its important to connect with a gout specialist to determine if KRYSTEXXA with methotrexate is right for you. […] A gout specialist is a doctor who has experience treating uncontrolled gout. Find a gout specialist who can help you decide if KRYSTEXXA is right for you. […] KRYSTEXXA is the only gout treatment that controls chronic gout by changing uric acid into a water-soluble substance called allantoin that your body easily gets rid of through urine.

• #20 Gout and Pseudogout Treatment & Management: Approach Considerations, Treatment of Acute Attacks, Treatment of Chronic Gout

  https://emedicine.medscape.com/article/329958-treatment

  To reduce this undesired effect, colchicine or low-dose NSAID treatment is provided for at least 6 months. […] Allopurinol blocks xanthine oxidase and thus reduces the generation of uric acid. […] Febuxostat, a nonpurine selective inhibitor of xanthine oxidase, is a potential alternative to allopurinol in patients with gout. […] In 2010, the FDA approved pegloticase for chronic gout refractory to conventional therapy. […] Vitamin C, with its uricosuric effect, may reduce the serum concentration of uric acid. […] Benzbromarone is an effective uricosuric agent that was never approved for use in the United States because of concerns over hepatotoxicity.

• #21 Treatment of hyperuricaemia and gout

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4954312/

  Alternative urate-lowering strategies comprise uricosuric drugs, such as sulfinpyrazone, probenecid and benzbromarone, or allopurinol desensitisation […] Strategies to reduce the risk of ULT-induced acute attacks include delaying initiation of ULT until the acute attack has resolved, starting ULT at a low dose and slowly escalating the dose, co-prescription of colchicine, NSAIDs or corticosteroids when initiating ULT, and educating patients to expect an attack of gout after starting ULT […] Recently, there has been interest in the use of biologic agents that inhibit interleukin 1 (IL-1), such as canakinumab, rilonacept and anakinra, to treat acute gout.

• #22 Treatment and management of gout: the role of pharmacy – The Pharmaceutical Journal

  https://pharmaceutical-journal.com/article/ld/treatment-and-management-of-gout-the-role-of-pharmacy

  Using the T2T approach, allopurinol or feboxustat should be titrated until the serum urate target is reached. […] When starting people on long-term treatment, discuss the risks and benefits of prophylactic medication to prevent acute flares. […] Irrespective of whether prophylactic medication is used or not, it is extremely important to advise the patient that they should continue with allopurinol or feboxustat if they develop an acute flare and that add-in treatment will be prescribed for their flare. […] Acute flares are best treated with either low-dose colchicine of 500 micrograms twice daily or with an NSAID, preferably co-prescribing an NSAID with a proton pump inhibitor for gastric protection. […] The pharmacy team is a central component of the primary care team, with many practices and primary care networks directly employing or sharing a pharmacy team. When treating gout, pharmacists can use their in-depth understanding of medicines and their interactions, helping to ensure a clear T2T pathway and shorter waiting times for patients.

• #23 A New View on Gout Flares and Treatments | Arthritis Foundation

  https://www.arthritis.org/health-wellness/treatment/treatment-plan/disease-management/gout-flares-gout-treatments

  New research is revealing further insights into the causes of gout and gout flares as well as the best gout treatments. Traditionally viewed as a form of inflammatory arthritis, gout treatment has primarily focused on controlling uric acid levels that cause crystals to form around joints, causing profound pain in patients. Gout is an inflammatory syndrome, and it is not driven to anyones knowledge by any autoimmune process. The session primarily focused on the autoinflammatory nature of gout and highlighted the inflammatory cytokine interlukin-1s (IL-1) role in gout. Several IL-1 blockers, including injectables anakinra, canakinumab and rilonacept, as well as a recently added oral option, NLRP3 inflammasome, are not specifically FDA-approved for gout, but they are proven treatments for blocking IL-1. Clinical data from IL-1-blocking injectable biologics in fact have validated the role of IL-1-beta in the pathogenesis of gout flares. In fact, oral NLRP3 IL-1 beta inflammasome inhibitors can now be used to treat gout flares in patients where traditional drugs are contraindicated or poorly tolerated. Urate-lowering therapy together with anti-inflammatory therapy leads to optimal outcomes. You dont just treat acute flares; you have to treat gout chronically. Any nonsteroidal anti-inflammatory drug (NSAID) may also be used; however, studies have not shown which NSAID works best. Other evidence presented by Dr. Schlesinger also included the anti-inflammatory effect of low- and moderate-intensity exercise in mice. Whats key, said Dr. Schlesinger, is we need to treat gout as an autoinflammatory disease and not purely a metabolic disease.

• #24 Gout: Treatment of flares – UpToDate

  https://www.uptodate.com/contents/gout-treatment-of-flares/print

  Our management approach is generally aligned with guidelines issued by the American College of Rheumatology (ACR) and European Alliance of Associations for Rheumatology (EULAR). When comparing various oral systemic treatments, several randomized trials evaluating glucocorticoids versus NSAIDs for gout flares demonstrated that glucocorticoids, when used at an appropriate dose and duration, are at least as efficacious as NSAIDs and may be associated with fewer serious adverse outcomes, particularly in comparison with indomethacin. Glucocorticoids are therefore increasingly favored by expert guideline panels as first-line therapy for gout flares. However, nonselective NSAIDs of all types are inexpensive and readily available to patients at the onset of a flare (some without a prescription), and short courses are probably as effective and safe as other agents for this indication.

• #25 Guidelines for the treatment of gout: a Swiss perspective

  https://smw.ch/index.php/smw/article/download/2218/3316?inline=1

  The recommended treatment dosages are: Naproxen 500 mg twice daily. Indomethacin 50 mg three times daily. Tenoxicam 40 mg once daily. Etoricoxib 120 mg once daily. […] Colchicine is an historical treatment for gout, but its use has had a poor reputation in Switzerland because of side effects, some of which were fatal. […] Corticosteroids are often used when an NSAID or colchicine are contraindicated, such as in patients who have severe renal impairment, but have also been compared directly with indomethacin in a randomised controlled trial and found to be equally effective and less likely to provoke gastrointestinal side effects. […] Interleukin-1 inhibitors have been shown to be effective in randomised controlled trials and in case series. […] Reducing the serum urate level in order to prevent crystal deposition and accumulation is the cornerstone of our therapeutic approach in gout.

• #26 A Different Kind of Uric Acid Treatment | KRYSTEXXA® (pegloticase)

  https://www.krystexxa.com/gout-treatment

  Attend a virtual event with a gout specialist on 5/14 […] Im exploring gout treatments […] KRYSTEXXA is the only FDA-approved treatment for out-of-control gout, and its approved to be given with methotrexate. […] Your doctor may prescribe KRYSTEXXA with methotrexate to reduce symptoms caused by out-of-control gout. […] KRYSTEXXA with methotrexate can significantly lower your uric acid level in 24 hours after the first IV treatment and help keep it there. […] At Month 6 in a clinical study, 71% of people receiving KRYSTEXXA with methotrexate kept their uric acid levels below 6 mg/dL, which is low enough to dissolve gout buildup, compared with 39% of people on KRYSTEXXA alone. […] At Month 12 in a clinical study, 31% of people receiving KRYSTEXXA alone dissolved at least 1 tophus, or gouty lump, compared with 54% of people receiving KRYSTEXXA with methotrexate.

• #27 Treatments for Gout | Arthritis Foundation

  https://www.arthritis.org/health-wellness/treatment/treatment-plan/disease-management/treatments-for-gout

  Adopting healthy lifestyle habits can help you improve your overall health, live better with gout, maintain your daily activities and potentially reduce your risk of gout attacks and joint damage. […] Adopting a healthy diet is the most important lifestyle factor in managing gout. In fact, some people can manage gout with dietary changes alone. […] Uric acid is produced when your body breaks down purine, a chemical that occurs naturally in your body as well as in certain foods. Avoiding foods high in purines including red and organ meats, some seafoods and alcohol may help you reduce uric acid levels in your blood and lower your risk of gout attacks. […] Losing weight if you are obese or overweight may reduce uric acid levels and your risk of gout attacks. Less weight also means less stress on painful joints.

• #28 5 Medically-Approved Gout Treatments | Treatment for Gout – Harvard Health

  https://www.health.harvard.edu/diseases-and-conditions/treatments-for-gout

  Treatment should begin within 24 hours of the start of the gout attack. First-line gout treatment focuses on reducing pain and inflammation. Ideally, treatment should begin within 24 hours of the start of the gout attack. A second goal of gout treatment is to bring down uric acid levels over the long term to prevent future attacks. Guidelines recommend that ULT be used primarily for people who have two or more gout flare-ups per year or those who have joint damage caused by gout. Urate-lowering therapy includes the following: Long-term treatment of gout often requires medication to prevent future gout attacks. The ACR guidelines recommend treating gout with uric acid-lowering medications for people who have tophi, radiographic evidence of damage due to gout, kidney stones or two or more gout flares per year. According to the ACR guidelines, the goal of medication therapy is to lower uric acid levels to less than 6 mg/dL. It’s important to note that urate-lowering therapy won’t make gout attacks stop right away. Gout flare-ups can last anywhere from several days to a week or longer. The following may help prevent gout attacks: Decrease alcohol, especially beer; Lose weight; Exercise daily; Limit your intake of red meat and shellfish; Limit your intake of sugary beverages; Choose healthy foods, such as dairy products, vegetables, nuts, legumes, fruits, and whole grains.

• #29 Gout: Rapid Evidence Review | AAFP

  https://www.aafp.org/pubs/afp/issues/2020/1101/p533.html

  Gout is caused by monosodium urate crystal deposition in joints and tissues. […] Colchicine, nonsteroidal anti-inflammatory drugs, and corticosteroids relieve pain in adults with acute gout episodes. […] Indications for long-term urate-lowering therapy include chronic kidney disease, two or more flare-ups per year, urolithiasis, the presence of tophus, chronic gouty arthritis, and joint damage. […] Allopurinol and febuxostat are used to prevent flare-ups, although febuxostat is associated with an increase in all-cause and cardiovascular mortality and is therefore not routinely recommended. […] The Dietary Approaches to Stop Hypertension (DASH) diet was associated with a lower risk of developing gout in a prospective cohort study in men during 26 years of follow-up. […] Behavior modifications should be recommended, including a low-fat, low-purine diet; avoidance of alcohol; weight loss if overweight; increased exercise; and avoidance of soft drinks and foods containing fructose.

• #30 Gout Treatment | Weirton Medical Center

  https://wvumedicine.org/weirton/services/rheumatology/gout/

  Gout is a condition caused by an excess of uric acid in your body, which may result from the body either producing too much or excreting too little. The board-certified rheumatologist at Weirton Medical Center specializes in the treatment of gout and other rheumatic conditions. To meet with our rheumatologist and discuss your symptoms and discover what treatment options will work best for you, please call our rheumatology clinic at 304-797-6000 today. […] Treatments for gout are designed to reduce either the pain and inflammation of individual attacks or the frequency of attacks. Traditional treatments include making dietary changes and taking certain medications. […] Maintaining a balanced diet that is low in uric acid is important for lowering the risk of a gout attack. Following a Mediterranean diet that includes plant-based proteins, vegetables, fruits and nuts can have a favorable impact on reducing the risk of metabolic syndrome. Avoiding foods high in purines, such as red meat, alcohol, and high fructose corn syrup, will also help gout medicine be more effective and prevent flare-ups.

• #31 Gout

  https://www.nhs.uk/conditions/gout/

  Gout can come back every few months or it may be years. It can come back more often if it’s not treated. […] If you have frequent attacks or high levels of uric acid in your blood, you may need to take uric acid-lowering medicine. […] It’s important to take uric acid-lowering medicine regularly, even when you no longer have symptoms. […] Attacks of gout are usually treated with a non-steroidal anti-inflammatory (NSAID), like ibuprofen. […] If the pain and swelling does not improve you may be given steroids as tablets or an injection. […] Making healthy lifestyle choices may mean you can stop or reduce further gout attacks. […] Get treatment immediately if you feel an attack starting.

• #32 Gout Treatment – Gout Education

  https://gouteducation.org/gout-treatment/

  Like many other medications for blood pressure or high cholesterol, uric acid-lowering medicines also known as urate-lowering medicines are meant to be taken daily for life in order to lower uric acid levels and manage them in order to prevent gout attacks. They should not be discontinued even when a gout attack is over to continue helping your body to remove uric acid from your blood. […] Though it seems like your health is back to normal once the gout attack ends, the underlying cause of the disease an elevated serum uric acid level needs to be controlled. Medications for pain and inflammation can be stopped, as directed after pain and inflammation subside, but urate-lowering therapy must be continued for life. Otherwise, more gout attacks could occur while your serum uric acid level is still out of control.

• #33 Gout Treatment – Gout Education

  https://gouteducation.org/gout-treatment/

  Like many other medications used for treating chronic conditions such as high blood pressure or high cholesterol, uric acid-lowering medicines are meant to be taken daily for life in order to lower uric acid levels and prevent the progression of the disease. They should not be discontinued, even if a gout flare occurs. […] While gout is a lifelong condition, it can be managed or even completely controlled by sticking with a proper treatment plan. The combination of the right medications and lifestyle changes for lowering uric acid will stop the build-up of more uric acid crystals, which cause the excruciating pain of gout attacks and the crippling arthritis associated with uncontrolled gout over years and decades. […] Medication adherence is essential, but diet modification and exercise are still recommended.

• #34

  https://bpac.org.nz/2021/gout-part1.aspx

  Urate-lowering treatment should be discussed with all patients with gout once a diagnosis has been established. […] Patients with symptomatic hyperuricaemia and any of the following should start urate-lowering treatment: Two or more flares per year, tophi or erosions on X-ray, renal impairment, past urolithiasis, serum urate level 0.54 mmol/L. […] Regular use is the key to long-term management. […] Rongo rkau (traditional plant remedies with healing properties) may be used by some Mori patients to treat flares of gout. Urate-lowering medicines can be used safely in combination with Rongo rkau and should not be discouraged.

• #35 Treatments for Gout | Arthritis Foundation

  https://www.arthritis.org/health-wellness/treatment/treatment-plan/disease-management/treatments-for-gout

  Regular physical activity, particularly between gout attacks, is an important part of your gout treatment plan. Research suggests that regular low- to moderate-intensity exercise can reduce uric acid levels. Regular activity can also play a role in a weight loss plan and can help keep joints mobile. However, you should speak with your doctor before exercising during an acute attack. […] Despite your best efforts to manage gout, you may need to consider surgery at some point to repair the damage caused by gout. Tophi are nodules made up of uric acid crystals that can form over the structures around the joints. Tophi may become chronically inflamed, break open and become infected. Removal may be recommended to reduce the risk of complications. If uric acid crystals in the joints are causing intense pain, arthroscopic removal of uric acid may be an effective way to relieve pain. If long-term inflammation damages the smaller joints of the hands, making movement painful and difficult, a procedure called joint fusion is an option for relief. A joint that is severely damaged by gout may be surgically removed and replaced with a prosthesis, improving mobility and relieving pain.

• #36

  https://arthritis.ca/about-arthritis/arthritis-types-(a-z)/types/gout/gout-treatment

  After a first gout attack, your doctor will discuss with you whether you may benefit from medications to help lower the level of uric acid in your bloodstream. […] To achieve lower bloodstream levels of uric acid, your doctor may prescribe a medication. Medications that reduce uric acid levels will prevent future gout attacks and keep the condition from becoming chronic. […] Allopurinol is a medication used to lower uric acid levels. It can take several weeks for the effects to become noticeable. […] Surgery is rarely required for gout. Occasionally, surgery is considered for people who have suffered from gout over a long period of time to remove problematic tophi or to repair badly damaged joints. However, with proper medication and treatment, these situations are generally avoided.

• #37 Refractory Gout Management | National Kidney Foundation

  https://www.kidney.org/kidney-topics/refractory-gout-management

  Refractory gout causes painful joints and is hard to treat. Managing it includes medicine, healthy eating, and exercise, especially if you have kidney disease. […] Refractory gout (also known as treatment failure gout) is a clinical condition that is characterized by serum uric acid levels that do not fall below 6mg/dL, and ongoing symptoms of recurrent flares, chronic inflammatory arthritis, and increased tophi. Despite available therapies, the inability to manage the disease and maintain serum uric acid levels 6 mg/dL remains a significant challenge. […] Therapies aimed at prevention of future attacks and management of chronic gout include reducing risk factors, dietary and lifestyle interventions, and urate-lowering therapy. […] Long-term prophylaxis with urate lowering therapy is used to maintain serum urate levels below 6 mg/dL, while considering the individual needs of the patient. Xanthine oxidase inhibitors (XOIs), uricosuric, and uricase agents are three classes of drugs approved for lowering urate levels to help prevent acute flares and development of tophi in patients with gout.

• #38 Refractory Gout Management | National Kidney Foundation

  https://www.kidney.org/kidney-topics/refractory-gout-management

  Pegloticase, a modified recombinant uricase, is available for chronic gout that is refractory to conventional treatment. It is administered intravenously every 2 weeks. Studies have shown its efficacy in lowering urate levels and reducing tophi in this patient subpopulation. […] The optimal management of refractory gout has been an ongoing challenge despite the availability of multiple therapeutic options. Adequate diagnosis, timely treatment of acute attacks, optimal management of chronic gout, and appropriate adjustment of treatment regimens for cases of refractory gout can offer the best opportunities to improve patient outcomes.

• #39 Treatment of Gout in Patients with CrCl ≤30 mL/min and/or on Hemodialysis: A Review

  https://www.mdpi.com/2674-0621/4/1/5

  Managing gout patients with CKD poses significant challenges, as many first-line gout drugs like NSAIDs, colchicine, and high-dose corticosteroids have safety concerns in CKD, including the risk of acute kidney injury. Urate-lowering therapies also require dose adjustment and monitoring, leading to therapeutic nihilism and undertreatment of gout in advanced CKD. However, uncontrolled gout can lead to recurrent attacks, joint damage, and a poor quality of life. Emerging therapies offer hope, but high-quality evidence on managing gout in CKD remains scarce. […] Despite the difficulties, treating uric acid levels is important to control gout and prevent CKD progression and complications in this high-risk population. Inadequate treatment contributes to frequent hospitalizations and poor outcomes. This review paper aims to examine the various approaches to managing gout in patients with Creatinine Clearance ≤30 mL/min and/or on hemodialysis, highlighting the critical need for more research to provide evidence-based guidance on the safest and most effective therapies for gout patients with impaired kidney function. Such efforts can significantly reduce the burden of both diseases for patients and the healthcare system.

• #40 5 Types of PT Treatments for Gout | Back in Motion

  https://mainephysicaltherapy.com/5-types-of-pt-treatments-for-gout/

  Gout can be a painful experience, but there are ways to help manage it. One way is physical therapy, which can be helpful in managing gout flare-ups. […] Physical therapy techniques can help reduce inflammation during a gout attack. These techniques can also help you regain movement and build strength to help you maintain your joint health in the long run. […] Physical therapy is a beneficial treatment for gout, especially in the rehabilitation phase. Gout affects the joints, and physical therapy offers treatment to address joint and soft tissue concerns to help improve mobility, reduce pain and reduce the risk of future flare-ups. Effective physical therapy techniques to treat gout include: […] Your physical therapist can create a tailored exercise program targeted around your specific needs and concerns based on the affected joints. Therapeutic exercises can help strengthen the muscles around your affected joints.

• #41 5 Types of PT Treatments for Gout | Back in Motion

  https://mainephysicaltherapy.com/5-types-of-pt-treatments-for-gout/

  Your physical therapist will create your personalized treatment plan based on your unique symptoms and concerns with gout. Theyll guide you through each step to help you manage your gout and get back to enjoying your life. […] Our expert physical therapists will work closely with you to create a personalized treatment plan that may include manual therapy techniques, therapeutic exercises or other modalities that aim to help manage pain, improve joint health and prevent future flare-ups.

• #42 The management of gout: Much has changed

  https://www.racgp.org.au/afp/2016/may/the-management-of-gout-much-has-changed

  Once target serum urate has been reached, six-monthly monitoring by testing serum urate is recommended to ensure continuing adequate management and adherence. […] Febuxostat is a newer agent used to treat gout that works by inhibiting xanthine oxidase the same mechanism as allopurinol. […] The increasing prevalence and impact of gout mean that greater focus is required to ensure best outcomes for patients. […] Generally speaking, the most important strategy is to treat to a serum urate target (0.36 mmol/L in most people) as this is critical to preventing gout flares and resolving tophi.

• #43 Gout | Conditions | UCSF Health

  https://www.ucsfhealth.org/conditions/gout

  Although there is no cure for gout, the majority of patients are able to manage their symptoms with medications. […] Gout is caused by a buildup of uric acid in the body. Most patients are able to ease symptoms and stop a gout attack with either nonsteroidal anti-inflammatory drugs or corticosteroids. Patients who suffer repeated gout attacks or advanced gout may need different medications to normalize their levels of uric acid. […] Most people with gout are able to control their symptoms and enjoy active lives with the use of proper medication. Treatment aims to reduce pain, prevent future attacks and avoid the development of tophi and kidney stones. […] Nonsteroidal anti-inflammatory drugs (NSAIDs), or corticosteroids, which are either taken orally or injected into the affected joint, are two of the most common treatments for acute attacks of gout.

• #44 Gout: Symptoms, Treatment & Prevention

  https://my.clevelandclinic.org/health/diseases/4755-gout

  Theres no cure for gout. You’ll experience fewer attacks once you work with a healthcare provider to find treatments that manage your symptoms and lower your uric acid levels. […] The best way to prevent gout is to limit how often you consume high-purine foods and drinks. […] Most people with gout eventually find a combination of treatments and lifestyle tweaks to manage their symptoms and reduce how often they experience gout attacks. Gout is treatable.

• #45 Treatment and management of gout: the role of pharmacy – The Pharmaceutical Journal

  https://pharmaceutical-journal.com/article/ld/treatment-and-management-of-gout-the-role-of-pharmacy

  Gout is a common form of arthritis but despite being easily treatable, often goes undiagnosed or undertreated. This article explains the causes and symptoms of gout and the treatment strategy required to therapeutically ‘cure’ gout through lifelong medication. […] The NICE guidelines advise a ‘treat-to-target’ (T2T) approach for gout, with the aim being to bring urate levels below clinically significant levels and, therapeutically, ‘cure’ the condition. Doing this essentially ‘switches off’ the immune system and stops the chronic, persistent inflammatory process of gout in the body. […] Long-term treatment with allopurinol or feboxustat should be offered to all patients. This is typically recommended to be started two to four weeks after the acute flare but, in patients who are struggling with very frequent flares, the NICE guidance allows for long-term treatment to be started immediately.

• #46 The management of gout: Much has changed

  https://www.racgp.org.au/afp/2016/may/the-management-of-gout-much-has-changed

  Gout is a common problem that is increasing in prevalence in Australia. […] The objective of this article is to provide an update on the management of gout. […] Developments in treatment strategies for gout and newer agents to treat gout are discussed in this article. […] The salient points include the need to treat gout to a serum urate target, the ability to start allopurinol during acute attacks, the need to treat with prophylactic anti-inflammatory drugs for adequate time periods, and the availability of a new urate-lowering drug on the Pharmaceutical Benefits Scheme (PBS). […] There have been a number of changes to the management of gout, including dosing strategies of older drugs and availability of newer therapeutics. […] Treating patients to a target serum urate is essential for reducing gout flares and resolving tophi.

• #47 Gout/Gouty Arthritis In Depth: Risk Factors, Treatment | HSS

  https://www.hss.edu/conditions_gout-risk-factors-diagnosis-treatment.asp

  Gout can be extremely painful and incapacitating but is extremely treatable in almost all patients. Its important to identify and treat it early to avoid pain and complications. […] Gout is a common disease. It has been estimated that there may be as many as five million gout sufferers in the United States. […] The management of an acute flare of gout is very different from the prevention of subsequent attacks. […] Treatments used for prevention, such as allopurinol, can actually make things worse if given during a flare, and so need to be held back until the flare has resolved for several weeks. […] If an attack of gout is allowed to last more than a day or so before treatment is started, the response to treatment may be much slower. […] Nonsteroidal anti-inflammatory drugs (NSAIDs) or COX-2 inhibitors are the mainstay of therapy of acute attacks of gout in patients who have no contraindication to them.

• #48 Gout | Gouty Arthritis | MedlinePlus

  https://medlineplus.gov/gout.html

  Prevent tophi and kidney stones, for example with medicines that lower uric acid in the blood. […] With early diagnosis, treatment, and lifestyle changes, gout is one of the most controllable forms of arthritis. Treatment and lifestyle changes may help people avoid gout flares, lessen their symptoms, and sometimes even become gout free.

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