Treatment Of Gout In Patients Research Articles

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

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.

Analysis of the Economic-Financial Efficiency of Gout Treatment in Elderly Patients with Comorbidities in the Republic of Moldova.

The costs of treating an elderly patient with gout are largely related to the treatment of concomitant pathological conditions and complications. Determining the costs of treating the disease is made by clinical and economic analysis, the task of which is to calculate the "cost of the illness". A descriptive, selective study of 237 patients with gout. In order to study the clinical characteristics of gout in the elderly, all those included in the study was divided according to age at the time of examination: group I made up of patients with gout up to and including 59 years n=91, average age 48.1±7.4 years (from 30 years to 59 years), group II - over the age of 60 years inclusive n=146, average age 69.2±6.0 years, (60-86 years, p<0.01). For calculations, the hospitalisation rate during the year was used, which had significant differences in groups: in group I it was 0.7; in group II - 1.2 (p=0,001). The costs of clinical management of gout and each of the diseases that accompany it for 1 calendar year have been determined. The direct costs for the treatment of patients with gout, calculated taking into account National Clinical Protocol and comorbid pathology, increase significantly with the age of the patients: the average cost per year of the treatment of gout in patients of mature age was 1337 Euro without and 7320 Euro taking into account the concomitant pathology, and in the elderly 2067 Euro and, respectively, 15230 Euro.

Clinical observation of Febuxostat in the treatment of gout patients with different body fat levels.

Clinical observation of Febuxostat in the treatment of gout patients with different body fat levels.

Managing hyperuricemia and gout in chronic kidney disease: a clinical conundrum.

There is controversy regarding the impact of hyperuricemia on the progression of chronic kidney disease (CKD), and gout remains sub optimally managed in this population. We discuss the prescribing of drugs for the treatment of gout in patients with CKD. There is a lack of consensus from expert guidelines, and prescribers have concerns regarding the risk of adverse reactions from medicines used to treat gout. These situations appear to contribute to suboptimal management of gout in this cohort. Recent data have challenged the role of urate lowering therapy (ULT) in the management of asymptomatic hyperuricemia in CKD. ULT should be commenced in all patients with severe, recurrent disease, tophaceous gout and evidence of joint damage. Most international guidelines recommend a treat-to-target approach for the management of gout. In CKD, ULT should be started at low dose with up titration adjusted to serum urate levels, rather than being based on the creatinine clearance. If patients fail first-line therapy, alternative agents are utilized, the specific agent depending on ease of access, burden of disease and other comorbidities. This approach should be incorporated into routine practice to ensure optimal treatment of gout in CKD. More research is required to investigate whether treatment of asymptomatic hyperuricemia has clinical benefits.

Cost-effectiveness of allopurinol versus febuxostat in the treatment of gout patients: A systematic review

Cost-effectiveness of allopurinol versus febuxostat in the treatment of gout patients: A systematic review

Gout management in Swiss primary care - a retrospective observational study.

Gout is the most common form of inflammatory arthritis worldwide and its prevalence is rising. In Switzerland, there are no data available on the characteristics and treatment of gout patients. In this study, we aimed to describe numbers of patients affected by gout and hyperuricaemia and unveil approaches Swiss primary care physicians (PCPs) use for the management. This was a retrospective observational study using electronic medical routine &nbsp;data provided from 242 Swiss PCPs. Included were all their patients receiving urate-lowering therapy (ULT), with a diagnostic code for gout or who had a serum uric acid (SUA) measurement. According to their disease status, patients were classified into four subgroups (normal urate, hyperuricaemia, untreated gout, treated gout). For treatment analysis, patients with SUA measurements before and after ULT initiation were included. Comorbidities and risk factors for secondary causes relevant in the context of gout were collected. Outcomes were prevalence of gout and hyperuricaemia, characteristics of patients according to subgroup, number of SUA measurements, levels of SUA and patients who reached the treatment goal of a SUA level &lt;360 &micro;mol/l. We assessed 15,808 patients and classified them into the subgroups. This yielded a prevalence of 1.0% for gout and 1.2% for hyperuricaemia. 2642 patients were diagnosed with gout of whom 2420 (91.6%) received a ULT. Overall; 41.3% of patients with a gout treatment had at least one SUA measurement; 15.0% of patients with treated gout had a record of SUA measurements before and after ULT initiation; and 57.5% reached the treatment goal of &lt;360 &micro;mol/l after allopurinol treatment. Swiss gout patients received comprehensive treatment, which is reflected in a high number of patients treated with ULT, laboratory tests per person and a high treatment success rate, although there is no systematic approach to the treatment of gout.

Clinical study of different doses of atorvastatin combined with febuxostat in patients with gout and carotid atherosclerosis

Objective:To evaluate the efficacy of atorvastatin combined with febuxostat in the treatment of gout patients with carotid atherosclerosis and to observe the effects on serum tumor necrosis factor-α (TNF-α), interleukin-1β (IL-1β), and C-reactive protein (CRP) levels, carotid plaques, and the adverse reactions.Methods:Seventy patients with gout and carotid atherosclerosis admitted to Affiliated Hospital of Hebei University from January 2014 to June 2017 were randomly divided into a treatment group and a control group. The treatment group received oral febuxostat 40 mg/day combined with atorvastatin 40 mg/day. The control group was given 40 mg/day febuxostat combined with 20 mg/day atorvastatin for 90 days. The effects of treatment on TNF-α, IL-1β, and CRP levels and carotid plaques of the patients were observed.Results:After 90 days of treatment, serum TNF-α, IL-1β, and CRP levels, as well as HUA and total cholesterol (TC), decreased in both groups after treatment. There were significant differences observed (p < 0.05). The carotid artery plaques in the two groups were significantly smaller after treatment (P<0.05). There was no significant difference in adverse reactions between the two groups (P > 0.05).Conclusion:Double doses of atorvastatin combined with febuxostat can effectively reduce uric acid to improve the inflammatory state in patients and reduce carotid plaques without increasing the incidence of adverse reactions.

Gout Severity in Recipients of Kidney Transplant

PurposeThis retrospective analysis of medical chart data was performed to compare severity and treatment of gout in patients with or without a history of kidney transplantation (KT). MethodsVia an online survey, a panel of board-certified US nephrologists (N = 104) provided the following deidentified chart data for their 3 most recent patients with gout: age, sex, serum uric acid, numbers of swollen or tender joints, visible tophi, gout flare events (prior 12 months), gout drug treatment history, and KT history. The presence of “severe, uncontrolled gout” was defined as: serum uric acid ≥ 7.0 mg/dL, ≥1 tophi and ≥2 flares in the last 12 months, and history of xanthine oxidase inhibitor treatment. ResultsTwenty-five out of 312 (8.0%) gout patients had a history of KT. Univariate analysis found that patients with gout and history of kidney transplants had: greater prevalence of severe uncontrolled gout (27% vs 8%, P = .007) and tophi (36% vs 17%, P = .030), and higher rates of failure or physician perceived contraindication to allopurinol (44% vs 23%, P = .028). ConclusionThis study provides preliminary evidence that gout in patients with history of KT is more severe and poses greater challenges to pharmacologic management. Although gout has been linked to worse outcomes among kidney recipients in the literature, there are presently no publications on gout severity among patients with KT in comparison to other patients with gout. Further investigation of disease severity and appropriate, effective treatment options in recipients of kidney transplant with a diagnosis of gout, especially prior to the transplant, is warranted.

Impact of pegloticase on patient outcomes in refractory gout: current perspectives.

Gout is currently the most frequent cause of inflammatory arthritis worldwide and is responsible for poor health-related quality of life and loss of work productivity. It is caused by high levels of serum urate, leading to the deposition of monosodium urate crystals in joints and soft tissues. This condition is associated with acute flares and, if untreated or refractory, chronic and potentially destructive arthritis and tophi formation. Pegloticase is a recombinant, pegylated uricase used in the treatment of gout patients who fail conventional urate-lowering therapy. In this review, we discuss the impact of pegloticase on patient outcomes in refractory gout. We analyze different parameters, such as plasma uric acid concentration, frequency of flares, tophi reduction, pain, function, quality of life, and safety.

Febuxostat in the treatment of gout patients with low serum uric acid level: 1-year finding of efficacy and safety study

To retrospectively analyze the efficacy and safety of febuxostat on gout patients with low serum uric acid level. A study was conducted in Nanjing First Hospital from October 2015 to September 2016. Thirty nine acute gouty arthritis patients from the emergency and outpatient department were included. Patients met the 2015 Gout Classification Criteria revised by American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) and had urate deposition around the joints detected by dual-energy computerized tomography (DECT). Patients whose serum uric acid (SUA) were between 5.0 and 7.0mg/dl (300-420μmol/l) received febuxostat treatment to maintain the SUA level between 3.0 and 5.0mg/dl for 1year. Efficacy and safety of febuxostat were observed during the process. Three of 39 subjects were excluded because of adverse events (AEs) after receiving an initial febuxostat treatment for 2months. Thirty six subjects were enrolled. The mean SUA level was reduced significantly from 6.51 ± 0.28mg/dl at baseline to 4.24 ± 0.38mg/dl and SUA of all subjects decreased by 34.8% compared with baseline. After 1-year treatment, the volume of tophus was reduced approximately 62.8%. Serum creatinine decreased stepwise in 8 gout patients with chronic kidney diseases from 162.5 ± 9.2μmol/l to 131.4 ± 11.0μmol/l. Two months after initiation of treatment, the number of gout flares began to markedly decrease and almost did not occur after 1year. After the 1-year treatment of febuxostat, the average SUA level declined significantly, and the renal function improved gradually. There was nearly complete abolition of gout flares by the end of the study. Tophi resolved markedly compared with baseline as assessed by DECT. Furthermore, only a few people experienced adverse events. Febuxostat has a notable effect for gout patients in the lower SUA level range.

Lesinurad: a novel therapeutic option in the pharmacotherapy of gout

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. Current therapies for chronic gout include mainly allopurinol and febuxostat. Inspite of the availability of these medications for several years, a significant number of patients do not have adequate control of uric acid levels resulting in acute gout flares. Lesinurad is the most recent drug molecule approved by US FDA &amp; EMA for the treatment of gout in patients with uncontrolled gout along with allopurinol. Lesinurad prevents reabsorption of uric acid from the renal tubules, resulting in uricosuria. The efficacy of the lesinurad was demonstrated in three randomized phase 3 controlled clinical trials where the drug was primarily evaluated in the setting of background therapy with allopurinol or febuxostat. There is a definite risk of nephrotoxicity with monotherapy and when the drug is used in patients who have inadequate renal function. The drug does appear to be relatively safe, though the inconclusive cardiovascular safety of the drug has prompted the regulatory agency to mandate post marketing trials to evaluate the safety of this molecule. Nevertheless, lesinurad does appear to have a lot of promise as a front line drug molecule in the control of hyperuricemia.

Cost-effectiveness analysis of HLA-B5801 genotyping in the treatment of gout patients with chronic renal insufficiency in Korea.

Allopurinol-induced severe cutaneous adverse reactions (SCARs) are relatively rare but cause high rates of morbidity and mortality. Studies have shown that the HLA-B5801 allele and renal impairment are strongly associated with SCARs. Recent American College of Rheumatology guidelines recommend that, prior to treatment with allopurinol, the HLA-B5801 genotype of gout patients at high risk for SCARs, including Korean patients with chronic renal insufficiency, should be determined. However, whether such genotyping is cost-effective is unknown. This study evaluated the cost-effectiveness of HLA-B5801 genotyping for the treatment of gout in patients with chronic renal insufficiency in Korea. A decision analytical model over a time period of 12 months was employed to compare the cost and outcomes of treatment informed by HLA-B5801 genotyping with that of a conventional treatment strategy using a hypothetical cohort of gout patients with chronic renal insufficiency. Direct medical costs were obtained from real patients with SCARs from 2 tertiary hospitals. Outcomes were measured as a total expected cost and an incremental cost-effectiveness ratio. In the base model, the total expected cost and probability of continuation of gout treatment without SCARs for the conventional and HLA-B5801 screening strategies were $1,193 and 97.8% and $1,055 and 100%, respectively. The results were robust according to sensitivity analyses. Our model suggests that gout treatment informed by HLA-B5801 genotyping is less costly and more effective than treatment without genotyping, and HLA-B5801 genotyping could considerably reduce the occurrence of allopurinol-induced SCARs and related deaths.

Treatment of gout patients with impairment of renal function: a systematic literature review.

To assess the efficacy and safety of gout-specific medications in gout patients with a comorbidity and/or comedication. A systematic literature search for gout, its medication, and the most common comorbidities and comedications, using serum uric acid (SUA) levels as the primary, and adverse events as the secondary outcomes. Eight trials met inclusion criteria. Trials covered treatment with allopurinol, benzbromarone, rasburicase, or febuxostat in a gout population with mild or moderate renal insufficiency. High risk of bias (5/8 trials) and heterogeneity precluded formal metaanalysis. The trials showed the following hierarchy in efficacy (lowering the SUA below 6.0 mg/dl): febuxostat 80 mg (44%-71%) > febuxostat 40 mg (43%-52%) > allopurinol 100 mg or 200 mg (0-46%) after 6 months of therapy; rasburicase (46%) > allopurinol 300 mg (16%) after 7 days of therapy; benzbromarone 100-200 mg (93%) > allopurinol 100-200 mg (63%) after 9-24 months of therapy. The combination of allopurinol and benzbromarone seemed to be effective, with a significant reduction in the SUA from 7.8 to 5.7 mg/dl (p < 0.05) after 1 month. One study showed that 89% achieved the target SUA using higher doses of allopurinol than usually recommended for patients with renal impairment without an apparent increase in adverse events. In addition, allopurinol and benzbromarone significantly improved renal function. In gout patients with renal insufficiency febuxostat, rasburicase, benzbromarone, and allopurinol + benzbromarone seemed to be effective and safe; allopurinol may be cautiously titrated until the target uric acid level has been reached, and may improve renal function.

Leczenie dny moczanowej u pacjentów po przeszczepieniu narządu

Występowanie dny moczanowej u pacjentów poddanych przeszczepowi narządu stanowi istotny problem, sprawiający niejednokrotnie trudności diagnostyczne i terapeutyczne. Hiperurykemia występuje u 5–84%, a dna u 1,7–28% pacjentów po przeszczepieniu narządu miąższowego. U biorców narządów obok powszechnie występujących w populacji czynników ryzyka istnieją czynniki charakterystyczne dla tej grupy, takie jak: stosowanie diuretyków, leków immunosupresyjnych oraz, bardzo często współistniejące, upośledzenie funkcji nerek lub nerki przeszczepionej. Częstość występowania napadów dny zależy w dużej mierze od stosowanego u chorego leczenia immunosupresyjnego. Najwięcej napadów dny występuje podczas stosowania cyklosporyny. Leczenie dnawego zapalenia stawów u pacjentów po przeszczepieniu sprawia często wiele trudności z powodu istotnych interakcji lekowych oraz współistnienia niewydolności nerek. Najlepszy profil bezpieczeństwa w tym zakresie wykazuje mykofenolan mofetylu. Istotny w zmniejszeniu ryzyka napadów dny jest również właściwy dobór leków hipotensyjnych.

MAO inhibitors (December 2010)

A reader comments on the use of monoamine oxidase inhibitors to treat depression (December 2010) and on the treatment of gout in patients with chronic kidney disease (December 2010).

Gout and chronic kidney disease (December 2010)

A reader comments on the use of monoamine oxidase inhibitors to treat depression (December 2010) and on the treatment of gout in patients with chronic kidney disease (December 2010).

Survey of Current Trends for Diagnosis and Treatment in Korean Gout Patients

Objective. The prevalence of gout has increased so accurate diagnosis and constant treatment is important in its management. The purpose this study was to examine the current trends in the diagnos is and treatment of gout patients in Korea. Methods. We enrolled patients who were diagnosed as having gout and received treatment in university hospital between 2005 and 2008. From the survey, we assessed and analyzed the patient's baseline characteristics, clinical aspects of gout attack, medical institution and specialized department in the first gouty attack, medical institution and specialized department where the gout was initially diagnosed, methods of diagnosis, treatment during gout attack, and knowledge about gout in patients. Results. A total of 136 patients were included in this study, out of which 123 (90.4%) were male and the mean age was 55.2 (range 25∼85) years. When patients experienced the first gout attack, the most common medical institution that they attended was a private clinic and the most common specialized department was orthopedics. Medication by oral route was the major method (80.9%) used for the treatment of gout, and the most common medication was a non-steroidal anti-inflammatory drug (NSAID) in 55.9%, allopurinol in 38.2% and colchicine in 20.6% of patients. Many gout patients inappropriately received allopurinol following signs of gout arthritis attack, with little information specifically about gout. Conclusion. In our survey, many gout patients received inadequate medications for the treatment of gout and had little knowledge about the disease. For the adequate treatment of gout, patients and doctors need to be educated sufficiently.

Running the Numbers

### Background Asymptomatic hyperuricaemia is the most important risk factor in the development of gout, as the risk of acute arthritis rises exponentially with the serum levels of uric acid. It is a common condition, estimated at 15-20% in the general population and even though asymptomatic, approximately 20% of patients with untreated high uric acid levels develop gout over the following 5 years. Unfortunately there is not enough data available about subclinical urate crystal deposition and the joint damage that it causes. ### Objectives This study aimed to demonstrate that high levels of serum uric acid can induce changes suggestive of gout in the hyaline cartilage, joints and tendons of patients with asymptomatic hyperuricaemia. ### Method The study was a cross-sectional study on 30 patients with hyperuricaemia with no history of gout. An ultrasound examination on the knees and first methatarsophalangeal joints was performed. ### Results Synovitis was found in 7 patients (23%), 6 patients had erosions (20%), 9 patients had tophaceous material (30%) and 2 patients had DCS (6.6%). There was a slightly higher rate of findings in men than in women (8 men vs 5 women). ### Conclusion The study confirms that sustained high levels of serum uric acid can induce subclinical articular and periarticular urate deposits, synovitis and joint erosions that are detectable on ultrasound. These ultrasound findings may allow early diagnosis and treatment of gout in patients with hyperuricaemia. ### References Find all the books, read about the author, and more. See search results for this author. Are you an author? Learn about Author Central. Hochberg MC, Silman AJ, Smolen JS, Weinblatt ME, Weisman MH. Rheumatology, 5th ed. 2011. Doherty M. New insights into the epidemiology of gout, Rheumatology (2009) 48 (suppl 2) ii2-ii8. doi 10.1093/rheumatology/kep086. Neogi T. Asymptomatic hyperuricemia: perhaps not so benign? J Rheumatol 2008;35:734-737. Pineda C, Amezcua-Guerra LM, Solano C, Rodriguez-Henríquez P, Hernández-Díaz C, Vargas A, Hofmann F, Gutiérrez M. Joint and tendon subclinical involvement suggestive of gouty arthritis in asymptomatic hyperuricemia: an ultrasound controlled study. Arthritis Res Ther 2011 Jan 17;13(1):R4. doi: 10.1186/ar3223. De Miguel E, Puig JG, Castillo C, Peiteado D, Torres RJ, Martín-Mola E. Diagnosis of gout in patients with asymptomatic hyperuricaemia: a pilot ultrasound study. Ann Rheum Dis 2012;71:157-158. doi:10.1136/ard.2011.154997. Puig JG, De Miguel E, Castillo MC, Rocha AL, Martinez MA, Torres RJ: Asymptomatic hyperuricemia impact of ultrasonography. \[abstract\] Nucleosides Nucleotides Nucleic Acids 2008;27:592-595. Chowalloor PV, Keen HI. A systematic review of ultrasonography in gout and asymptomatic hyperuricaemia \[abstract\] Ann Rheum Dis 2013;72:5 638-645. ### Disclosure of Interest None declared