An update on the management of hyperuricemia and gout

Gout is a common chronic inflammatory arthritis that can lead to significant disability. Gout is one of the few rheumatologic diseases that can be diagnosed with certainty and can be cured with appropriate therapy. Alcohol and dietary consumption are related to hyperuricemia and gout attacks. A moderate intake of purine-rich vegetables or protein is not related to an increased risk of gout. A weight-reducing, calorie-restricted diet with moderate carbohydrate restriction was beneficial for gout patients and reduced the serum uric acid and frequency of gout attacks, although these findings need to be confirmed. Clinicians should consider therapeutic options that do not increase the serum uric acid when treating associated conditions in gout patients. The acute gout attack can be treated appropriately with non-steroidal anti-inflammatory drugs, colchicine, or glucocorticoids. Hypouricemic treatment reduces the uric acid concentration by inhibiting its production (allopurinol) or enhancing its excretion (benzbromarone). Allopurinol is the agent used most commonly, but the recommended dose often fails to control the serum uric acid. Benzbromarone effectively reduces the serum uric acid, but possible hepatotoxicity should be monitored. Febuxostat, a new xanthine oxidase inhibitor, was recently approved by the Federal Drug Administration (FDA). PEGylated uricase, a potent parenteral hypouricemic agent, is under investigation for the treatment of gout.