Carlo Alberto Scirè1,2, Cristina Rossi3, Leonardo Punzi4, Augusto Genderini5, Claudio Borghi6, Walter Grassi7. 1. a Epidemiology Unit , Italian Society for Rheumatology , Milan , Italy. 2. b Rheumatology Unit, Department of Medical Sciences , University of Ferrara , Italy. 3. c Italian College of General Practitioners and Primary Care , La Spezia , Italy. 4. d Rheumatology Unit, Department of Medicine DIMED , University of Padova , Italy. 5. e Unit of Nephrology and Dialysis , Luigi Sacco University Hospital-Campus , Milan , Italy. 6. f Ospedale Policlinico S.Orsola-Malpighi , University of Bologna , Bologna , Italy. 7. g Clinica Reumatologica , Università Politecnica delle Marche , Ancona , Italy.
Abstract
BACKGROUND: Despite being regarded as an easily-treatable disease, gout diagnosis and management can be challenging. REVIEW: This review discusses current issues in gout management and proposes some potential solutions. Gout diagnosis should be reached as early as possible and often requires specific tests, such as synovial fluid analysis or imaging techniques that are not available in most centers, leaving healthcare professionals to rely only on clinical presentations and their experience. In addition, gout management requires the evaluation of multiple aspects, such as monitoring of serum uric acid (sUA) level (which should be reduced to <6 mg/dL) to ensure adherence and efficacy of treatment, evaluation of patient's risk profile and comorbidities, and continuous assessments to manage clinical manifestations. An important premise in gout management is non-pharmacological intervention; however, pharmacological urate-lowering therapy is crucial for an optimal control of the disease. Available options include xanthine-oxidase inhibitors (XOI), targeting uric acid overproduction, and uricosuric agents which target the predominant cause of hyperuricemia (under-excretion). Among these, lesinurad is the novel uricosuric agent to be used in combination with XOI in patients with gout not adequately controlled with XOI alone, which can further contribute to the control of hyperuricemia in gout. CONCLUSIONS: Multidisciplinary management is crucial for the diagnosis and treatment of gout, in order to ensure treatment continuity and improve management. This review, therefore, advises that educational activities for General Practitioners and specialists should be implemented to help raise awareness on gout diagnosis, monitoring, and treatment.
BACKGROUND: Despite being regarded as an easily-treatable disease, gout diagnosis and management can be challenging. REVIEW: This review discusses current issues in gout management and proposes some potential solutions. Gout diagnosis should be reached as early as possible and often requires specific tests, such as synovial fluid analysis or imaging techniques that are not available in most centers, leaving healthcare professionals to rely only on clinical presentations and their experience. In addition, gout management requires the evaluation of multiple aspects, such as monitoring of serum uric acid (sUA) level (which should be reduced to <6 mg/dL) to ensure adherence and efficacy of treatment, evaluation of patient's risk profile and comorbidities, and continuous assessments to manage clinical manifestations. An important premise in gout management is non-pharmacological intervention; however, pharmacological urate-lowering therapy is crucial for an optimal control of the disease. Available options include xanthine-oxidase inhibitors (XOI), targeting uric acid overproduction, and uricosuric agents which target the predominant cause of hyperuricemia (under-excretion). Among these, lesinurad is the novel uricosuric agent to be used in combination with XOI in patients with gout not adequately controlled with XOI alone, which can further contribute to the control of hyperuricemia in gout. CONCLUSIONS: Multidisciplinary management is crucial for the diagnosis and treatment of gout, in order to ensure treatment continuity and improve management. This review, therefore, advises that educational activities for General Practitioners and specialists should be implemented to help raise awareness on gout diagnosis, monitoring, and treatment.