Effectiveness of interventions for the treatment of acute and prevention of recurrent gout—a systematic review

Abstract

The shortage of robust data to inform the management of a common problem such as gout is surprising. All of the drugs used to treat gout can have serious side effects. The incidence of gout is highest in the elderly population. It is in this group, who are at a high risk of serious adverse events, that we are using drugs of known toxicity. The balance of risks and benefits for the drug treatment of gout needs to be reassessed.

Crystal-Induced Neutrophil Activation: XI. Implication and Novel Roles of Classical Protein Kinase C

“…Moreover, all of the drugs used to treat gout can have serious side effects (58). In addition, evidence was recently provided that men with gout have an increased risk of death as the result of an elevated risk of cardiovascular diseases, particularly coronary heart diseases (59).…”

Biochemical effectiveness of allopurinol and allopurinol-probenecid in previously benzbromarone-treated gout patients

“…On the other hand, benzbromarone seems well tolerated in general use [5] in contrast to allopurinol, which causes frequently (2-5%) allergic skin reactions. The uncertainty remains whether the efficacy-safety balance of benzbromarone really is unfavourable, compared to the other antihyperuricemic drugs available like allopurinol, probenecid and sulphinpyrazone [6]. In Europe, benzbromarone was available only as a prescription uricosuric drug in a limited number of countries.…”

“…Therefore, theoretically, the urate balance, in terms of the ratio of overproduction and underexcretion of urate, may be clinically important for the rational choice of a uricostatic drug, a uricosuric drug or a combination of both. However, there are no trials to support or refute this theory [6]. From observational studies, it is concluded that benzbromarone 75-120 mg/day is very effective in the control of hyperuricemia, better than allopurinol 300-450 mg/day [5,15,16].…”

Diet in hyperurykemia and gout – myths and facts

“…Nonetheless, each patient greatly benefits from low-purine diet, and its effects in some patients are comparable to those achieved via medical treatment. Moreover, altering eating habits is more cost-effective and safer than pharmacotherapy, due to elimination of any drug-related side effects, which is especially important in the elderly [14]. This does not mean that medical therapy should be relinquished altogether, yet rational planning of the daily menu increases the chance of dose reduction (including complete discontinuation) and eliminates a number of risk factors for the development of gout (e.g.…”