Update on hyperuricaemia and gout with evidence based management guidelines
Gout is now the leading cause of inflammatory arthritis, affecting 1–2% of the population. The metabolic syndrome, cardiovascular risk factors, cardiovascular events and mortality are more common with gout. However, the role of uric acid as an independent risk factor is inconclusive. The identificat...
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| Format: | Article |
| Language: | English |
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AOSIS
2015-07-01
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| Series: | South African Family Practice |
| Subjects: | |
| Online Access: | https://safpj.co.za/index.php/safpj/article/view/4162 |
| _version_ | 1828125745325539328 |
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| author | Girish M. Mody |
| author_facet | Girish M. Mody |
| author_sort | Girish M. Mody |
| collection | DOAJ |
| description | Gout is now the leading cause of inflammatory arthritis, affecting 1–2% of the population. The metabolic syndrome, cardiovascular risk factors, cardiovascular events and mortality are more common with gout. However, the role of uric acid as an independent risk factor is inconclusive. The identification of urate transporters has improved our understanding of urate homeostasis and identified targets for the development of newer drugs. Experience with ultrasound and dual energy computed tomography led to the detection of urate crystals in patients with asymptomatic hyperuricaemia. Several evidence-based management guidelines are now available. The dietary and lifestyle recommendations focus on general health and management of comorbidities. A low dose colchicine regimen is effective and better tolerated than the traditional use of higher doses in acute gout. Alternative measures for acute gout include non-steroidal anti-inflammatory drugs (NSAIDs) and corticosteroids. Allopurinol is the most widely used initial therapy; treatment is started with 100 mg or less per day, and titrated upwards to achieve a target level of 0.36 mmol/l (in patients with tophi, a lower target of 0.30 mmol/l is recommended). A new non-purine more potent xanthine oxidase inhibitor, febuxostat, is available (currently not registered in South Africa). Probenecid is the most widely used uricosuric agent. Prophylactic therapy with colchicine, NSAIDs or corticosteroids is used when urate lowering therapy is initiated. Although the cause of gout is known and effective treatment is available, gout is poorly managed worldwide with failure to achieve the target urate level. |
| first_indexed | 2024-04-11T15:25:10Z |
| format | Article |
| id | doaj.art-dc02b6f1e5f4462eb71a525f8db96bc9 |
| institution | Directory Open Access Journal |
| issn | 2078-6190 2078-6204 |
| language | English |
| last_indexed | 2024-04-11T15:25:10Z |
| publishDate | 2015-07-01 |
| publisher | AOSIS |
| record_format | Article |
| series | South African Family Practice |
| spelling | doaj.art-dc02b6f1e5f4462eb71a525f8db96bc92022-12-22T04:16:16ZengAOSISSouth African Family Practice2078-61902078-62042015-07-0157410.4102/safp.v57i4.41623524Update on hyperuricaemia and gout with evidence based management guidelinesGirish M. Mody0Department of Rheumatology, School of Clinical Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa; and Inkosi Albert Luthuli Central Hospital, DurbanGout is now the leading cause of inflammatory arthritis, affecting 1–2% of the population. The metabolic syndrome, cardiovascular risk factors, cardiovascular events and mortality are more common with gout. However, the role of uric acid as an independent risk factor is inconclusive. The identification of urate transporters has improved our understanding of urate homeostasis and identified targets for the development of newer drugs. Experience with ultrasound and dual energy computed tomography led to the detection of urate crystals in patients with asymptomatic hyperuricaemia. Several evidence-based management guidelines are now available. The dietary and lifestyle recommendations focus on general health and management of comorbidities. A low dose colchicine regimen is effective and better tolerated than the traditional use of higher doses in acute gout. Alternative measures for acute gout include non-steroidal anti-inflammatory drugs (NSAIDs) and corticosteroids. Allopurinol is the most widely used initial therapy; treatment is started with 100 mg or less per day, and titrated upwards to achieve a target level of 0.36 mmol/l (in patients with tophi, a lower target of 0.30 mmol/l is recommended). A new non-purine more potent xanthine oxidase inhibitor, febuxostat, is available (currently not registered in South Africa). Probenecid is the most widely used uricosuric agent. Prophylactic therapy with colchicine, NSAIDs or corticosteroids is used when urate lowering therapy is initiated. Although the cause of gout is known and effective treatment is available, gout is poorly managed worldwide with failure to achieve the target urate level.https://safpj.co.za/index.php/safpj/article/view/4162african blacksevidence basedgoutguidelineshyperuricaemiareview |
| spellingShingle | Girish M. Mody Update on hyperuricaemia and gout with evidence based management guidelines South African Family Practice african blacks evidence based gout guidelines hyperuricaemia review |
| title | Update on hyperuricaemia and gout with evidence based management guidelines |
| title_full | Update on hyperuricaemia and gout with evidence based management guidelines |
| title_fullStr | Update on hyperuricaemia and gout with evidence based management guidelines |
| title_full_unstemmed | Update on hyperuricaemia and gout with evidence based management guidelines |
| title_short | Update on hyperuricaemia and gout with evidence based management guidelines |
| title_sort | update on hyperuricaemia and gout with evidence based management guidelines |
| topic | african blacks evidence based gout guidelines hyperuricaemia review |
| url | https://safpj.co.za/index.php/safpj/article/view/4162 |
| work_keys_str_mv | AT girishmmody updateonhyperuricaemiaandgoutwithevidencebasedmanagementguidelines |