Management of gout and hyperuricemia: Multidisciplinary consensus in Taiwan

Abstract

Gout is an inflammatory disease manifested by the deposition of monosodium urate (MSU) crystals in joints, cartilage, synovial bursa, tendons or soft tissues. Gout is not a new disease, which was first documented nearly 5,000 years ago. The prevalence of gout has increased globally in recent years, imposing great disease burden worldwide. Moreover, gout or hyperuricemia is clearly associated with a variety of comorbidities, including cardiovascular diseases, chronic kidney disease, urolithiasis, metabolic syndrome, diabetes mellitus, thyroid dysfunction, and psoriasis. To prevent acute arthritis attacks and complications, earlier use of pharmacotherapeutic treatment should be considered, and patients with hyperuricemia and previous episodes of acute gouty arthritis should receive long-term urate-lowering treatment. Urate-lowering drugs should be used during the inter-critical and chronic stages to prevent recurrent gout attacks, which may elicit gradual resolution of tophi. The goal of urate-lowering therapy should aim to maintain serum uric acid (sUA) level <6.0 mg/dL. For patients with tophi, the initial goal can be set at lowering sUA to <5.0 mg/dL to promote tophi dissolution. The goal of this consensus paper was to improve gout and hyperuricemia management at a more comprehensive level. The content of this consensus paper was developed based on local epidemiology and current clinical practice, as well as consensuses from two multidisciplinary meetings and recommendations from Taiwan Guideline for the Management of Gout and Hyperuricemia.

The effect of uricase on monosodium urate (MSU) crystallization, IL-1β and TNFα in monosodium urate-induced arthritis

“…Previous researchers have isolated urate from the joints of the limbs of patients with hyperuricemia [18], and it affects the development of gouty arthritis. With the exception of humans, primates, and birds, almost all animals synthesize and secrete uric acid oxidase which function is to decompose uric acid into water-soluble products such as allantoin [1]. Currently, artificially recombinant uricase is used in clinical trials, such as rasburicase and pegloticase.…”

“…Uric acid is the end product of nitrogen metabolism in birds, primates and humans [1], and hyperuricemia is a potential risk of gouty arthritis. Gouty arthritis, especially the joints of the extremities, is caused by poor uric acid excretion in the body [2][3][4].…”

Joint Clinical Consensus Statement of the American College of Foot and Ankle Surgeons® and the American Association of Nurse Practitioners®: Etiology, Diagnosis, and Treatment Consensus for Gouty Arthritis of the Foot and Ankle

“…There is little evidence demonstrating the efficacy of multidisciplinary care specific to outcomes in treatment of those with gout or hyperuricemia. A few consensus statements and recommendations have been produced using a multidisciplinary approach or consensus; however, they fall short in describing actual implementation of multidisciplinary care for such patients (95,151).…”

Rheumatologists' understanding of Refractory Gout: A questionnaire survey in China

“…All of the participants were informed on this survey before completing the anonymous questionnaire. Inclusion criteria required respondents to meet at least one of the following conditions: 1) rheumatologists with continuing medical education (CME) in gout; 2) rheumatologists who have studied the diagnosis and treatment guidelines for gout, including 2012 American College of Rheumatology (ACR) Guidelines for Management of Gout [4], 2018 EULAR Evidence-Based Recommendation: Diagnosis of Gout [5], 2018 Taiwan Multidisciplinary Consensus: Management of Gout and Hyperuricemia [6], 2016 Chinese Gout Diagnosis and Treatment Guide [7], 2017 Multidisciplinary expert consensus on diagnosis and treatment of hyperuricemia-related diseases in China [8], etc.…”