Recommendations of the Czech Society for Rheumatology for the treatment of gout
Authors:
K. Pavelka
Authors‘ workplace:
Revmatologický ústav Praha
Published in:
Čes. Revmatol., 27, 2019, No. 4, p. 166-176.
Category:
Recomendation
Overview
Epidemiological studies show a steady increase in the incidence of hyperuricemia and gout in the population. Gout therapy can be divided into the treatment of an acute gout attack and the issue of lowering uric acid levels. Any acute gout attack should be treated pharmacologically and treatment initiated immediately. As an alternative, colchicine, non-steroidal anti-inflammatory drugs and corticosteroids may be used. Combinations such as colchicine plus non-steroidal anti-inflammatory drugs or intra-articular corticosteroids with NSAIDs or colchicine can also be used in severe polyarticular, refractory attacks. In patients with severe refractory and frequent attacks, the interleukin-1 inhibitor canakinumab may be used. Patients indicated for hypouricemic treatment are those with a high frequency of attacks, tofi, and joint destruction. The treatment of hyperuricemia should be comprehensive and consist of non-pharmacological and pharmacological therapy. Medicaments that are available include uric-acid lowering drugs (allopurinol, febuxostat) and uricosuric agents (benzbromarone). Allopurinol is the drug of first choice, whereas febuxostat is recommended in the second line in patients who do not have shown sufficient response to or who are into- lerant of allopurinol. Febuxostat is suitable in patients with moderate renal insufficiency where a renal sparing effect has been demonstrated. Lesinurad, an inhibitor of the kidney URAT-1 transporter, is used in combination with allopurinol or febuxostat.
Keywords:
therapy – gout – febuxostat – lesinurad
Sources
1. Liu SC, Xia L, Zhang J, et al. Gout and risk of myocardial infarction: a systematic review and meta-analysis of cohort studies. Plos One 2015; 10: e0134088.
2. Edwards NL, So A. Emerging therapies for gout. Rheum Dis Clin North Am 2014; 40: 375–387.
3. Bardin T, Bouee S, Clerson P, et al. Prevalence of gout in the adult population of France. Arthritis Caare Res (Hoboken) 2016; 68: 261–266.
4. Kuo CF, Grainge MJ, Zhang W, et al. Global epidemiology of gout: prevalence, incidence and risk factors. Nat Rev Rheumatol 2015; 11: 649–662.
5. Wallace SL, Robinson H, Pascual E, et al. Preliminary criteria for the classification of acute arthritis of primary gout. Artrhitis Rheum 1977; 20: 895–900.
6. Zhang W, Doherty M, Pascual E, et al. EULAR evidence based recommendations for gout. Part I. Diagnosis. Ann Rheum Dis 2006; 65: 1301–1311.
7. Richette P, Doherty M, Pascual E, et al. 2016 updated EULAR evidence-based recommendations for the management of gout. Ann Rheum Dis 2017; 76: 29–42.
8. Terkeltaub RA, Furst DE, Bennet K, et al. High versus low dosing of oral colchicine for early acute gout flare: twenty-four hour outcome of the first, multicentre, randomized, double blind, placebo-controlled, parallel group, dose-comparison colchicin study. Arthritis Rheum 2019; 62: 1060–1068.
9. Rubib BR, Burrton R, Novarra S. Efficacy and safety profile of treatment with etoricoxib 120 mg once daily compared with indomethacin 50 mg three times daily in acute gout: a randomized controlled trial. Arthritis Rheum 2004; 50: 598–606.
10. Rainer TH, Chneg CH, Janssens HJ, et al. Oral prednisolone in the treatment of acute gout: a pragmatic, multicentre, double-blind, randomized trial. Ann Intern Med 2016; 164: 464–471.
11. Janssens HJ, Janssen M, et al. Use of oral prednisolone or naproxen for the treatment of gout arthritis: a double-blind, randomised equivalence trial. Lancet 2008; 371: 1854–1860.
12. Schlesinger N, Mysler E, et al. Canakinumab reduces the risk of acute gouty arthritis flares during initiation of allopurinol treatment: Results of double blind randomised study. Ann Rheum Dis 2011; 70: 1264–1271.
13. Bardin T. Canakinumab for the patient with difficult to treat gouty arthritis: review of the clinical evidence. Joint Bone Spine 2015; 82: eS9–eS16.
14. Khanna D, Fitzgerald JD, Khanna PP, Bae S, Singh MK, Neogi T, et al. American College of Rheumatology guidelines for management of gout. Part 1: systematic non-pharmacologic and pharmacologic therapeutic approaches to hyperuricemia. Arthritis Care Res (Hoboken) 2012; 64: 1431–1446.
15. Dessein PH, Shipton AE, Stanwix AE, et al. Beneficial effects of weight loss associated with moderate calorie/carbohydrate restriction and increased proportional intake of protein and unsaturated fat on serum and lipoprotein levels in gout a pilot study. Ann Rheum Dis 2000; 59: 539–543.
16. Pavelka K. Diagnostika a léčba dnavé artritidy a hyperurikémie. Farmakoterapeutická revue 2018; 3: 242–252.
17. Agarwal V, Hans N, Messerli FH, et al. Effect of allopurinol on blood pressure: a systematic review and metaanalysis. J Clin Hypertens 2013; 15: 435–442.
18. Keikar K, Kuo A, Frishman WH. Allopurinol as a cardiovascular drug. Cardiol Rev 2011; 19: 265–271.
19. Becker MA, Schumacher HR, Wortmann RL, et al. Effects of febuxostat versus allopurinol and placebo in reducing serum urate in subjects with hyperuricemia and gout: a 298 week, phase III randomized trial. Arthritis Care Res 2008; 59: 1540–1544.
20. Schumacher HR Jr, Becker MA, Wortmann RL, Macdonald PA, Hunt B, Streit J, et al. Effects of febuxostat versus allopurinol and placebo in reducing serum urate in subjects with hyperuricemia and gout: a 28-week, phase III, randomized, double-blind, parallel-group trial. Arthritis Rheum 2008; 59(11): 1540–1548.
21. White WB, Saag KG, Becker MA, et al. Cardiovascular safety of febuxostat or allopurinol in patients with gout. N Engl J Med 2018; 378: 1200–1210.
22. Bardin T, Keenan RT, Khanna PP, et al. Lesinurad in combination with allopurinol: a randomized, double blind, placebo controlled study in patients with gout with inaadequate response to standard of care the multinational CLEAR 2 study. Ann Rheum Dis 2017; 69: 203–212.
23. Saag KG, Fitz-Patrick D, Kopicko J, et al. Lesinurad combined with allopurinol Arthritis Rheum 2017; 69: 203–212.
24. Dalbeth N, Jones G, Terkeltaub R, et al. Lesinurad, a Selective Uric Acid Reabsorption Inhibitor, in Combination With Febuxostat in Patients With Tophaceous Gout: Findings of a Phase III Clinical Trial. Arthritis Rheumatol 2017; 69(9): 1903–1913.
25. Schumacher HR, Becker MA, Lloyd E, et al. Febuxostat in the treatment of gout. 5 year findings of the FOCUS efficacy and safety study. Rheumatology 2009; 48: 188–194.
26. Sundy JS, Becker MA, Baraf HS, et al. Reduction of plasma urate levels following treatments with multiple doses of pegloticase in patients with treatment failure gout results of phase II randomizes study. Arthritis Rheum 2008; 58: 2882–2891.
27. Sun M, Vazquaez AI, Reynolds RJ, et al. Untangling the complex relationship between incident gout risk, serum urate and its comorbidities. Arthritis Res Ther 2018; 20(1): 90.
28. Hill EM, Sky K, et al. Does starting allopurinol prolong acute treated gout? A randomized clinical trial. J Clin Rheumatol 2015; 21: 120–125.
29. Kilz V, Smolen J, Bardin T, et al. Treat to target (T2T) recommendations for gout. Ann Rheum Dis 2017; 76: 632–638.
30. Zhu Y, Pandya BJ, Choi HK. Comorbidities of gout and hyper-uricemia in the US general population. NHANES 2007–2008 Am J Med 2012; 125(7): 679–687.
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Czech Rheumatology
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