Advances in Therapy

, 28:748 | Cite as

Gouty arthritis: Understanding the disease state and management options in primary care



Acute gouty arthritis is an inflammatory response triggered by the release of monosodium urate crystal deposits into the joint space. The disease is associated with debilitating clinical symptoms and functional impairments as well as adverse economic and quality-of-life burdens. Because gouty arthritis is typically diagnosed and managed in the primary care setting, clinicians require a thorough knowledge of the presenting clinical features, risk factors, differential diagnoses, and treatment options for appropriate management. Although generally effective, the use of currently available therapies to control gouty arthritis is challenging because many medications used to treat comorbidities can exacerbate gouty arthritis and because current agents are associated with a number of adverse events, contraindications, or both. Based on an understanding of the underlying inflammatory pathogenesis of gouty arthritis, several new agents are being developed that may provide improved efficacy.


diagnosis emerging therapy gouty arthritis tophi uric acid uric acid lowering therapy 


  1. 1.
    Martinon F. Update on biology: uric acid and the activation of immune and inflammatory cells. Curr Rheumatol Rep. 2010;12:135–141.PubMedCrossRefGoogle Scholar
  2. 2.
    Nuki G, Simkin PA. A concise history of gout and hyperuricemia and their treatment. Arthritis Res Ther. 2006;8(suppl. 1):S1.PubMedCrossRefGoogle Scholar
  3. 3.
    Mandell BF. Clinical manifestations of hyperuricemia and gout. Cleve Clin J Med. 2008;75(suppl. 5):S5–S8.PubMedCrossRefGoogle Scholar
  4. 4.
    Eggebeen AT. Gout: an update. Am Fam Physician. 2007;76:801–808.PubMedGoogle Scholar
  5. 5.
    Becker MA, Ruoff GE. What do I need to know about gout? J Fam Pract. 2010;59(suppl. 6):S1–S8.PubMedGoogle Scholar
  6. 6.
    Keith MP, Gilliland WR. Updates in the management of gout. Am J Med. 2007;120:221–224.PubMedCrossRefGoogle Scholar
  7. 7.
    Zhu Y, Pandya B, Choi H. Increasing gout prevalence in the US over the last two decades: The National Health and Nutrition Examination Survey (NHANES). Arthritis Rheum. 2010;62:S901–S902.Google Scholar
  8. 8.
    Saag KG, Choi H. Epidemiology, risk factors, and lifestyle modifications for gout. Arthritis Res Ther. 2006;8(suppl. 1):S2.PubMedCrossRefGoogle Scholar
  9. 9.
    Lee SJ, Hirsch JD, Terkeltaub R, et al. Perceptions of disease and health-related quality of life among patients with gout. Rheumatology (Oxford). 2009;48:582–586.CrossRefGoogle Scholar
  10. 10.
    Choi HK, Curhan G. Independent impact of gout on mortality and risk for coronary heart disease. Circulation. 2007;116:894–900.PubMedCrossRefGoogle Scholar
  11. 11.
    Mapa JB, Pillinger MH. New treatments for gout. Curr Opin Investig Drugs. 2010;11:499–506.PubMedGoogle Scholar
  12. 12.
    Martinon F, Petrilli V, Mayor A, Mayor A, Tardivel A, Tschopp J. Gout-associated uric acid crystals activate the NALP3 inflammasome. Nature. 2006;440:237–241.PubMedCrossRefGoogle Scholar
  13. 13.
    Zhang W, Doherty M, Pascual E, et al. EULAR evidence based recommendations for gout. Part I: Diagnosis. Report of a task force of the Standing Committee for International Clinical Studies Including Therapeutics (ESCISIT). Ann Rheum Dis. 2006;65:1301–1311.PubMedCrossRefGoogle Scholar
  14. 14.
    Janssens HJ, Fransen J, van de Lisdonk EH, van Riel PL, van WC, Janssen M. A diagnostic rule for acute gouty arthritis in primary care without joint fluid analysis. Arch Intern Med. 2010;170:1120–1126.PubMedCrossRefGoogle Scholar
  15. 15.
    Dore RK. The gout diagnosis. Cleve Clin J Med. 2008;75(suppl. 5):S17–S21.PubMedCrossRefGoogle Scholar
  16. 16.
    Wallace SL, Robinson H, Masi AT, Decker JL, McCarty DJ, Yu TF. Preliminary criteria for the classification of the acute arthritis of primary gout. Arthritis Rheum. 1977;20:895–900.PubMedCrossRefGoogle Scholar
  17. 17.
    Urano W, Yamanaka H, Tsutani H, et al. The inflammatory process in the mechanism of decreased serum uric acid concentrations during acute gouty arthritis. J Rheumatol. 2002;29:1950–1953.PubMedGoogle Scholar
  18. 18.
    Thiele RG. Role of ultrasound and other advanced imaging in the diagnosis and management of gout. Curr Rheumatol Rep. 2011;13:146–153.PubMedCrossRefGoogle Scholar
  19. 19.
    Tolin MC, Navarra SV. Severe hip and knee pain in a man with chronic tophaceous gout. Int J Rheum Dis. 2009;12:57–60.PubMedCrossRefGoogle Scholar
  20. 20.
    Wortmann RL. Recent advances in the management of gout and hyperuricemia. Curr Opin Rheumatol. 2005;17:319–324.PubMedCrossRefGoogle Scholar
  21. 21.
    Nuki G. Colchicine: its mechanism of action and efficacy in crystal-induced inflammation. Curr Rheumatol Rep. 2008;10:218–227.PubMedCrossRefGoogle Scholar
  22. 22.
    Zhang W, Doherty M, Bardin T, et al. EULAR evidence based recommendations for gout. Part II: Management. Report of a task force of the EULAR Standing Committee for International Clinical Studies Including Therapeutics (ESCISIT). Ann Rheum Dis. 2006;65:1312–1324.PubMedCrossRefGoogle Scholar
  23. 23.
    Celebrex(celecoxib capsules) [product information]. New York, NY: Pfizer Inc.; 2011.Google Scholar
  24. 24.
    Napralen(naproxen sodium controlled-released tablets) [product information]. San Diego, CA: Victory Pharma, Inc.; 2011.Google Scholar
  25. 25.
    Colcrys™ (colchicine, USP tablets for oral use) [product information]. Corona, CA: Mutual Pharmaceutical Company, Inc.; 2009.Google Scholar
  26. 26.
    Terkeltaub RA, Furst DE, Bennett K, Kook KA, Crockett RS, Davis MW. High versus low dosing of oral colchicine for early acute gout flare: twenty-four-hour outcome of the first multicenter, randomized, double-blind, placebo-controlled, parallel-group, dose-comparison colchicine study. Arthritis Rheum. 2010;62:1060–1068.PubMedCrossRefGoogle Scholar
  27. 27.
    Prednisone tablets USP [product information]. Columbus, OH: Roxane Labratories, Inc.; 2002.Google Scholar
  28. 28.
    Janssens HJ, Lucassen PL, Van de Laar FA, Janssen M, van de Lisdonk EH. Systemic corticosteroids for acute gout. Cochrane Database Syst Rev. 2008:CD005521.Google Scholar
  29. 29.
    Mandell BF, Edwards NL, Sundy JS, Simkin PA, Pile JC. Preventing and treating acute gout attacks across the clinical spectrum: a roundtable discussion. Cleve Clin J Med. 2010;77(suppl. 5). S2–S25.PubMedCrossRefGoogle Scholar
  30. 30.
    Silva L, Miguel ED, Peiteado D, et al. Compliance in gout patients. Acta Reumatologica Portuguesa. 2010;35:466–474.PubMedGoogle Scholar
  31. 31.
    ALLOPURINOL (allopurinol tablet) [product information]. Corona, CA: Watson Laboratories, Inc.; 2006.Google Scholar
  32. 32.
    ULORIC® (Febuxostat tablet for oral use) [product information]. Deerfield, Ill: Takeda Pharmaceuticals America, Inc.; 2009.Google Scholar
  33. 33.
    Becker MA, Schumacher HR, Espinoza LR, et al. The urate-lowering efficacy and safety of febuxostat in the treatment of the hyperuricemia of gout: the CONFIRMS trial. Arthritis Res Ther. 2010;12:R63.PubMedCrossRefGoogle Scholar
  34. 34.
    PROBENECID [product information]. Corona, CA: Watson Pharmaceuticals Inc.; 2011.Google Scholar
  35. 35.
    KRYSTEXXA™ (pegloticase) Injection, for intravenous infusion [product information]. East Brunswick, NJ: Savient Pharmaceuticals, Inc.; 2010.Google Scholar
  36. 36.
    Baraf HS, Becker MA, Edwards NL, et al. Tophus response to peloticase (PGL) therapy: pooled results of GOUT 1 and GOUT 2 PGL phase 3 randomized, doubleblind, placebo-controlled trials. Arthritis Rheum. 2008;58(suppl. 9):S176.Google Scholar
  37. 37.
    So A, De Smedt T, Revaz S, Tschopp J. A pilot study of IL-1 inhibition by anakinra in acute gout. Arthritis Res Ther. 2007;9:R28.PubMedCrossRefGoogle Scholar
  38. 38.
    Chen K, Fields T, Mancuso CA, Bass AR, Vasanth L. Anakinra’s efficacy is variable in refractory gout: report of ten cases. Semin Arthritis Rheum. 2010;40:210–214.PubMedCrossRefGoogle Scholar
  39. 39.
    Terkeltaub R, Sundy JS, Schumacher HR, et al. The interleukin 1 inhibitor rilonacept in treatment of chronic gouty arthritis: results of a placebocontrolled, monosequence crossover, nonrandomised, single-blind pilot study. Ann Rheum Dis. 2009;68:1613–1617.PubMedCrossRefGoogle Scholar
  40. 40.
    So A, De Meulemeester M, Pikhlak A, et al. Canakinumab for the treatment of acute flares in difficult-to-treat gouty arthritis: results of a multicenter, phase II, dose-ranging study. Arthritis Rheum. 2010;62:3064–3076.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Healthcare 2011

Authors and Affiliations

  1. 1.The University of Texas Medical Branch (UTMB)Nassau BayUSA

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