Pathophysiology, Clinical Presentation and Treatment of Gout

Abstract

Gout is a common form of inflammatory arthritis that has been managed primarily in general medical practices for centuries. It appears that there has been an increasing prevalence of gout over the past decades, implying a growing public health burden. Accurate diagnosis and recognition of the various stages and manifestations of gout enable realistic goal setting for management. Recent evidence suggests new risk factors and potentially refutes others. Management of gout requires characterising and modifying risk factors and associated disorders, and commonly initiating drug therapy. Pharmacotherapy of gout includes the management of acute flares with anti-inflammatory agents such as NSAIDs and glucocorticoids and long-term treatment with urate-lowering drugs. Although pharmacotherapy is generally safe and effective, there are caveats and limitations to all gout therapies. Patient non-adherence and errors with the use of drugs for gout treatment are important factors leading to medical failures. With early intervention, careful monitoring and patient education, gout is a condition that can be managed very effectively. The advent of new drugs (such as febuxostat and urate oxidase [uricase]) and enhanced understanding of the pathogenesis of gout continue to improve our therapeutic options, particularly in a subset of patients with refractory disease and those who are intolerant to currently available medications.

Using Natural Language Processing and Machine Learning to Identify Gout Flares From Electronic Clinical Notes

“…Gout is an inflammatory arthritic condition associated with the crystallization of monosodium urate within synovial joints (1)(2)(3). Gout flares are the most common clinical finding in gout patients who have acute inflammation characterized by red, swollen, and painful joints (2,3).…”

“…Gout flares are the most common clinical finding in gout patients who have acute inflammation characterized by red, swollen, and painful joints (2,3).…”

Acute Pancreatitis Related to Therapeutic Dosing With Colchicine: A Case Report.

“…Patients with renal impairment have reduced colchicine clearance, may be more susceptible to colchicine toxicity and require cautious dosing [1,2]. In this case report, acute pancreatitis occurred in an elderly man with pre-existing renal impairment after two days of oral colchicine 1 mg daily for gout in the big toe.…”

“…Unlike with colchicine overdose-related pancreatitis [5,6,7], this patient did not experience severe colchicine toxicity, myelosuppression or deteriorating multi-organ dysfunction. Clinicians need to be cautious when prescribing colchicine in patients with renal impairment [1,2] as isolated acute pancreatitis (or potentially even more severe toxicity) may occur in these patients even with therapeutic doses of colchicine.…”

Febuxostat in the management of hyperuricemia and chronic gout: a review

“…It has been recognized that hyperuricemia may exist for many years before the fi rst clinical attack of gout (Falasca 2006). Hyperuricemia has been thought to be the fundamental pathogenic biochemical aberration upon which various etiological factors predispose to the expression of the clinical disorder of gout (Teng et al 2006). Moreover, hyperuricemia is also associated with chronic renal damage (Iseki et al 2004), some metabolic disturbances and risk factors for atherosclerotic cardiovascular disease including hypertension, overweight, insulin resistance, and hyperlipidemia (Slot 1994), which may occur together as the metabolic syndrome.…”