The treatment for chronic gout involves a combination of urate-lowering therapy, anti-inflammatory therapy, and lifestyle modifications.
Urate-lowering therapy
- Indications: Urate-lowering therapy is recommended for all patients with a diagnosis of gout, particularly those with recurring attacks, tophi, chronic gouty arthritis, joint damage, renal impairment, history of urolithiasis, diuretic use, or primary gout starting at a young age
- Treatment targets: The initial aim of urate-lowering therapy is to reduce and maintain the serum urate level ≤ 300 μmol/L to prevent further urate crystal formation and dissolve existing crystals . Once tophi have resolved and the patient remains symptom-free, the serum urate level should be maintained ≤ 360 μmol/L to avoid further crystal deposition and potential adverse effects associated with a very low serum urate level
- Treat-to-target strategy: A treat-to-target strategy of urate-lowering therapy dose management is recommended, which includes dose titration and subsequent dosing guided by serial serum urate values to achieve a serum urate target
- Medications: Allopurinol, a xanthine oxidase inhibitor, is frequently used in the treatment of chronic gout . Pegloticase is a potential new treatment option for patients intolerant to other urate-lowering therapies
Anti-inflammatory therapy
- Prophylaxis: Colchicine 500 mcg 1–2 times daily is recommended as prophylaxis against acute attacks resulting from initiation or uptitration of any urate-lowering therapy and should be continued for up to 6 months
- Acute attacks: Corticosteroids, NSAIDs, or colchicine are recommended for the treatment of patients with acute gout
- Frequent flares: IL-1 inhibitors should be considered for the treatment of flares in patients with frequent flares and contraindications to colchicine, NSAIDs, and corticosteroids
Lifestyle modifications
- Patient education: Patient education, appropriate lifestyle advice, and treatment of comorbidities are an important part of managing patients with gout
In conclusion, the treatment of chronic gout requires a comprehensive approach that includes urate-lowering therapy to control serum urate levels, anti-inflammatory therapy to manage acute attacks and prevent flares, and lifestyle modifications to reduce risk factors and improve patient outcomes. The goal is to reduce and maintain serum urate levels, manage acute attacks, and educate patients on lifestyle changes to improve their quality of life.