E K Li1. 1. Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong. edmundli@cuhk.edu.hk
Abstract
OBJECTIVE: To review the current understanding of the causes and the management of gout. DATA SOURCES: Publications on all peer-review literature from MEDLINE from 1965 to January 2004. STUDY SELECTION: Selected and evaluated by the author. DATA EXTRACTION: Extracted and evaluated by the author. DATA SYNTHESIS: The underlying metabolic disorder in gout is hyperuricaemia. Most patients with hyperuricaemia remain asymptomatic throughout their lifetime. The phase of asymptomatic hyperuricaemia ends with the first attack of gouty arthritis or urolithiasis. The risk of gout and stone formation is increased with the degree and duration of hyperuricaemia. Drugs available for the treatment of acute gouty arthritis, such as non-steroidal anti-inflammatory drugs, selective cyclo-oxygenase 2 inhibitors, systemic corticosteroids, or colchicine, are effective. For periods between attacks, prophylactic therapy, such as low-dose colchicine, is effective. In those with recurrent attacks of more than two to three times yearly, a uric acid-lowering agent as a long-term therapy should be considered to avoid recurrence and the development of tophaceous gout. CONCLUSIONS: Effective management of gout can be achieved through better understanding of the causes of the condition, preventive measures as well as drug treatment.
OBJECTIVE: To review the current understanding of the causes and the management of gout. DATA SOURCES: Publications on all peer-review literature from MEDLINE from 1965 to January 2004. STUDY SELECTION: Selected and evaluated by the author. DATA EXTRACTION: Extracted and evaluated by the author. DATA SYNTHESIS: The underlying metabolic disorder in gout is hyperuricaemia. Most patients with hyperuricaemia remain asymptomatic throughout their lifetime. The phase of asymptomatic hyperuricaemia ends with the first attack of gouty arthritis or urolithiasis. The risk of gout and stone formation is increased with the degree and duration of hyperuricaemia. Drugs available for the treatment of acute gouty arthritis, such as non-steroidal anti-inflammatory drugs, selective cyclo-oxygenase 2 inhibitors, systemic corticosteroids, or colchicine, are effective. For periods between attacks, prophylactic therapy, such as low-dose colchicine, is effective. In those with recurrent attacks of more than two to three times yearly, a uric acid-lowering agent as a long-term therapy should be considered to avoid recurrence and the development of tophaceous gout. CONCLUSIONS: Effective management of gout can be achieved through better understanding of the causes of the condition, preventive measures as well as drug treatment.