Gout and Hyperuricemia: Recent Advances and a Systematic Review

Abstract

Gout is an increasingly common rheumatic disease. Global studies have found an increase in mean serum urate in both genders during the past four decades. Furthermore, there has been a resurgence of interest in hyperuricemia as an independent and potential modifiable cardiovascular risk factor. This work discusses recent advances in the epidemiology, pathogenesis, clinical manifestations, and treatment of gout and hyperuricemia. Humans have an uricase silencing mutation together with effective renal tubule urate reabsorption, thus resulted in a high urate levels. From evolutionary point of view, hyperuricemia should be biologically relevant. However, the exact role of uric acid as an end product of purine metabolism in human remains unclear. It is important to point out that many gout patients are not been adequately managed and highlighting the burden of gout and hyperuricemia. Recent advances in understanding of the molecular mechanisms of renal urate handling may help in developing better uricosuric agents in the future. Though it remains uncertain whether hyperuricemia is an independent risk factor for cardiovascular disease, a diagnosis of hyperuricemia or gout should prompt a search for cardiovascular risk factors. If data supporting treatment of hyperuricemia to prevent cardiovascular or renal disease become available in the future, such data will significantly change the way we treat asymptomatic hyperuricemia. However, well-designed randomized controlled study is necessary to clarify this. From evidence-based point of view, the current treatment practices of patients with gout, including long-term prevention of gout recurrence, are largely empirical. For example, the long-term effect of allopurinol or uricosuric agents on renal function and their relative safety is still unknown and requires examination via a well designed, randomized controlled study.