Does the initiation of urate-lowering treatment during an acute gout attack prolong the current episode and precipitate recurrent attacks: a systematic literature review

Eminaga, Fatma; La-Crette, Jonathan; Jones, Adrian; Agarwal, Abhishek

doi:10.1007/s00296-016-3579-z

Cited by 19 publications

(10 citation statements)

References 8 publications

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“…35 ULT should not be stopped during gout flares and American College of Rheumatology guidance supports starting ULT during a flare. 7,16 However, recent EULAR and BSR guidelines still recommend that ULT is best delayed until inflammation has settled as ULT is better discussed when the patient is not in pain.…”

Section: Urate Lowering Therapymentioning

confidence: 99%

An update on the management of gout

2018

DTB

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Gout is the most common form of inflammatory arthritis and its incidence in the UK has steadily increased from 1.5% in 1997 to 2.5% in 2012. It is characterised by deposition of monosodium urate crystals in joints and tissues and usually presents with intermittent painful attacks followed by long periods of remission. It has been suggested that the management of gout in the UK remains suboptimal. In 2004, we concluded that there was a woeful lack of evidence to guide treatment or prophylaxis for gout, particularly with regard to choice of drug or doses. The introduction of new drugs and new evidence on the efficacy and safety of treatment options has led the European League Against Rheumatism (EULAR) and the British Society of Rheumatology (BSR) to update their guidelines on the management of gout. Nevertheless, there are differing views on target serum uric acid (SUA) levels and the role of urate lowering treatment (ULT). Here, we review the latest guidance on the management of gout and consider the role of long-term ULT.

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Section: Urate Lowering Therapymentioning

confidence: 99%

An update on the management of gout

2018

DTB

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“…Another potential issue lies in the possibility of initiating ULT during a gout flare: some studies suggest that ULT used as soon as possible during the acute phase of the disease might improve compliance and yield better outcomes [ 55 , 56 ], whereas others suggest that the early treatment might lead to more frequent flares [ 57 ]. Even existing guidelines disagree in these regards [ 58 – 60 ]; a meta-analysis study found no significant effect of initiation of ULT during a gout flare on pain severity and flare duration, although high heterogeneity and the low number of studies included did not allow drawing definite conclusions [ 61 ]. There is solid evidence, suggesting that gout flares frequently develop during the first several months of ULT, owing to dissolution of small tophi in intra-articular spaces resulting in release of needle-shaped crystals, which can in turn promote inflammation: to prevent this risk, it is generally suggested to start with a low dose and progressively titrate up to the full dose [ 62 ] while also providing anti-inflammatory prophylaxis with low-dose colchicine, corticosteroids, or NSAIDs [ 44 ].…”

Section: Resultsmentioning

confidence: 99%

Relationship between hyperuricemia with deposition and sexual dysfunction in males and females

Sansone

Reisman

Jannini

2022

J Endocrinol Invest

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Purpose The association between gout, the most common crystal arthropathy, and sexual dysfunctions has often been investigated by studies in the last decades. Despite the presence of shared risk factors and comorbidities and the possible effects on sexual health of long-term gout complications, awareness of this association is severely lacking and the pathogenetic mechanisms have only partially been identified. In the present review, we aimed to investigate the current evidence regarding the potential mechanisms linking sexual dysfunctions and gout. Methods A comprehensive literature search within PubMed was performed to provide a summary of currently available evidence regarding the association between gout and sexual dysfunctions. Results Gout and sexual dysfunctions share several risk factors, including diabesity, chronic kidney disease, hypertension, metabolic syndrome, and peripheral vascular disease. Gout flares triggered by intense inflammatory responses feature severe pain and disability, resulting in worse sexual function, and some, but not all, treatments can also impair sexual health. Long-term gout complications can result in persistent pain and disability due to joint deformity, fractures, or nerve compression, with negative bearing on sexual function. The presence of low-grade inflammation impairs both sex steroids synthesis and endothelial function, further advancing sexual dysfunctions. The psychological burden of gout is another issue negatively affecting sexual health. Conclusions According to currently available evidence, several biological and psychological mechanisms link sexual dysfunctions and gout. Addressing risk factors and providing adequate treatment could potentially have beneficial effects on both conditions. Appropriate clinical evaluation and multidisciplinary approach are recommended to improve patient care.

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“…No signi cant intergroup difference in VAS score improvement was noted. According to a previous review, the early initiation of allopurinol does not increase pain severity or acute gout attack [20]. Therefore, the early intervention of hyperuricemia using a combination of colchicine and probenecid could prevent GA with acute ares.…”

Section: Discussionmentioning

confidence: 99%

Early urate-lowering therapy in gouty arthritis with acute flares: a double-blind placebo controlled clinical trial

Yang

Wei

2022

Preprint

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Background Gouty arthritis (GA) is a chronic systemic disease with recurrent acute monoarthritis. In a previous study, a higher incidence of acute flares was observed during the initial marked decrease in serum urate level. Our study evaluated the effect of early urate-lowering therapy in patients with acute GA flares. Methods This study included 40 patients with acute GA; of them, 20 received colchicine 0.5 mg colchicine twice daily, while 20 received probenecid 500 mg and colchicine 0.5 mg twice daily. We evaluated GA severity and laboratory data for two weeks after the initial therapy. Results Rapidly decreasing serum uric acid levels was found in the patients treated with probenecid and colchicine compared with the patients treated with colchicine alone on day 8 (-1.77 ± 2.037 vs 1.24 ± 2.084; P < 0.0001). However, the mean decrease in visual analog scale score did not differ significantly between the two groups (-5.20 ± 3.09 vs -3.63 ± 2.38; P = 0.079). Conclusion No significant increase was noted in acute gout flare severity or duration among GA patients treated with early aggressive control of hyperuricemia using probenecid plus colchicine.

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Does the initiation of urate-lowering treatment during an acute gout attack prolong the current episode and precipitate recurrent attacks: a systematic literature review

Cited by 19 publications

References 8 publications

An update on the management of gout

An update on the management of gout

Relationship between hyperuricemia with deposition and sexual dysfunction in males and females

Early urate-lowering therapy in gouty arthritis with acute flares: a double-blind placebo controlled clinical trial

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