Gout – management of a chronic disease: a systematic review

Petruţa Violeta Filip 1 , Sorina Laura Diaconu 1 , 2 , Diana Chetroiu 1 , 2 , Denisa Cuciureanu 2 , and Corina Silvia Pop 1 , 2
  • 1 Internal Medicine III Department, University Emergency Hospital Bucharest, Bucharest, Romania
  • 2 ”Carol Davila” University of Medicine and Pharmacy, , Bucharest, Romania


Objectives: Gout is the most common inflammatory arthritis of the 21 century, but is still frequently misdiagnosed. This review aims to provide guidance for gout management in clinical practice, which includes the diagnosis, treatment of acute episodes, but also long-term therapy to reduce serum urate, as well as lifestyle changes and prevention of recurrent episodes.

Design: Systematic review without meta-analysis.

Methods: We have systematically searched Google Scholar, PubMed, and all relevant worldwide guidelines to identify and select clinical guidelines for gout. We have included eligible gout articles according to predefined inclusion and exclusion criteria after selecting titles, abstracts and full texts. The characteristics of the recommendations reported in the guidelines included were extracted and analyzed.

Results: We selected 27 eligible papers and tried to facilitate the identification of recommendations for the treatment of gout in the acute phase, but also in the chronic phase. The recommendations were detailed and explained during this extensive review.

Conclusions: Despite the availability of effective serum urate reduction therapies, overall gout management is poor. Achieving therapeutic goals is often low both at the initiation of therapy and in long-term treatment. Optimal strategies for managing gout are necessary in both acute and chronic gout flames in patients who are prone to the development of this pathology.

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  • 1. Tang SCW. Uric Acid in Chronic Kidney Disease Gout: A Disease of Kings. Contrib Nephrol. Basel, Karger. 2018; 192:77-81.

  • 2. Richette P, Doherty M, Pascual E et al. 2018 updated European League Against Rheumatism based recommendations for the diagnosis of gout. Ann Rheum Dis. 2020; 79(1):31-38.

  • 3. Abhishek A, Roddy AE, Doherty M. Gout – a guide for the general and acute physicians. Clinical Medicine. 2017; 17(1):54-59.

  • 4. Coburn BW, Mikuls TR. The Problem with Gout Is That It’s Still Such a Problem. J Rheumatol. 2016; 43(8):8-11.

  • 5. Hui M, Carr A, Cameron S et al. The British Society for Rheumatology Guideline for the Management of Gout. Rheumatology. 2017; 56(7):e1–e20,6.

  • 6. Michael P, Bs MPR, Monjazeb S, Goodwin BP, Group AR. Ulcerated tophaceous gout. 2019:0-3. Dermatol Online J. 2019; 25(3):1-3.

  • 7. Hainer BL, Matheson E, Wilkes RT. Diagnosis, Treatment, and Prevention of Gout. Am Fam Physician. 2014; 90(12):831-836.

  • 8. Singh JA. Racial and Gender Disparities in Patients with Gout. Curr Rheumatol Rep. 2013; 15(2):1-15.

  • 9. Pittman JR, Pharm D, Bross MH. Diagnosis and Management of Gout. Am Fam Physician. 1999; 59(7):1799-1806.

  • 10. Scirè CA, Manara M, Cimmino MA et al. Gout impacts on function and health-related quality of life beyond associated risk factors and medical conditions: results from the KING observational study of the Italian Society for Rheumatology (SIR). Arthritis Res Ther. 2013; 15(5):R101.

  • 11. Yu KH, Luo SF, Liou LB et al. Concomitant Septic and Gouty Arthritis-An Analysis of 30 Cases. 2 Rheumatology (Oxford). 2003; 42(9):1062-6.

  • 12. Moi JHY, Sriranganathan MK, Falzon L et al. Lifestyle Interventions for the Treatment of Gout: A Summary of 2 Cochrane Systematic Reviews. J Rheumatol Suppl. 2014; 92:26-32.

  • 13. Kuo C, Grainge MJ, Mallen C, Zhang W, Doherty M. Rising burden of gout in the UK but continuing suboptimal management: a nationwide population study. Ann Rheum Dis. 2015; 74:661–667.

  • 14. Khanna D, Fitzgerald JD, Khanna PP et al. 2012 American College of Rheumatology Guidelines for Management of Gout Part I: Systematic Nonpharmacologic and Pharmacologic Therapeutic Approaches to Hyperuricemia. NIH Public Access. 2013; 64(10):1431-1446.

  • 15. Jordan KM, Cameron JS, Snaith M et al. British Society for Rheumatology and British Health Professionals in Rheumatology Guideline for the Management of Gout. Rheumatology (Oxford). 2007; 46(8):1372-4.

  • 16. HR Jr, Boice JA et al. Randomised double blind trial of etoricoxib and indometacin in treatment of acute gouty arthritis. BMJ. 2002; 324(7352):1488-92.

  • 17. Chen LC, Ashcroft DM. Risk of myocardial infarction associated with selective COX-2 inhibitors: Meta-analysis of randomised controlled trials. Pharmacoepidemiol Drug Saf. 2007; 16(7):762-72.18.

  • 18. Burns CM, Wortmann RL. Latest evidence on gout management: what the clinician needs to know. Ther Adv Chronic Dis. 2012; 3(6):271-286.

  • 19. Hein J, Janssen M, Hvan de Lisdonk E et al. Use of oral prednisolone or naproxen for the treatment of gout arthritis: a double-blind, randomised equivalence trial. Lancet. 2008; 371(9627):1854-1860.

  • 20. Sattui SE, Gaffo AL. Treatment of hyperuricemia in gout: current therapeutic options, latest developments and clinical implications. Ther Adv Musculoskel Dis. 2016; 8(4):145-159.

  • 21. Zhang Y, Neogi T, Chen C et al. Cherry Consumption and the Risk of Recurrent Gout Attacks. Arthritis Rheum. 2012; 64(12):4004-4011.

  • 22. Li Q, Li X, Wang J et al. Diagnosis and treatment for hyperuricemia and gout : a systematic review of clinical practice guidelines and consensus statements. BMJ Open. 2019; 9:e026677.

  • 23. Vargas-Santos AB, Peloquin CE, Zhang Y, Neogi T. Association of Chronic Kidney Disease With Allopurinol Use in Gout Treatment. JAMA Intern Med. 2018; 178(11):1526-1533.

  • 24. Goicoeche M, García de Vinuesa S, Verdalles U et al. Effect of Allopurinol in Chronic Kidney Disease Progression and Cardiovascular Risk. Clin J Am Soc Nephrol. 2010; 5(8):1388-93.

  • 25. Macdonald PA, Eustace D, Palo WA, Streit J et al. Febuxostat Compared with Allopurinol in Patients with Hyperuricemia and Gout. N Engl J Med. 2005; 353:2450-2461.

  • 26. Avena-Woods C, Hilas O. Febuxostat (Uloric), A New Treatment Option for Gout. Drug Forecast. 2010; 35(2):82-85.

  • 27. Guttmann A, Krasnokutsky S, Pillinger MH, Berhanu A. Pegloticase in gout treatment - safety issues, latest evidence and clinical considerations. Ther Adv Drug Saf. 2017; 8(12):379-388.


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