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How to manage gout in everyday clinical practice

Despite being regarded as an easy-to-treat disease, gout diagnosis and management can be challenging for primary care practitioners. A review published recently in the Current Medical Research and Opinion journal discussed current issues in gout management and proposed some potential solutions.

The review highlighted the importance of reaching a gout diagnosis as early as possible. However, a gout diagnosis often requires specific tests, such as synovial fluid analysis or imaging techniques that are not available in most centres, leaving healthcare professionals to rely only on clinical presentations and their experience.

In addition, the review stressed that gout management requires the evaluation of multiple aspects, such as monitoring of serum uric acid 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 – 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 xanthine-oxidase inhibitors in patients with gout not adequately controlled with XOI alone, which can further contribute to the control of hyperuricemia in gout.

The review concluded that multidisciplinary management is crucial for the diagnosis and treatment of gout, in order to ensure treatment continuity and improve management. It advised that educational activities for general practitioners and specialists should be implemented to help raise awareness on gout diagnosis, monitoring, and treatment.

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Carlo Alberto Scirè, Cristina Rossi, Leonardo Punzi, Augusto Genderini, Claudio Borghi & Walter Grassi (2018) Change gout: how to deal with this “silently-developing killer” in everyday clinical practice, Current Medical Research and Opinion, 34:8, 1411-1417, DOI: 10.1080/03007995.2018.1454896

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