Refractory gout: what is it and what to do about it?
- 1 March 2008
- journal article
- review article
- Published by Ovid Technologies (Wolters Kluwer Health) in Current Opinion in Rheumatology
- Vol. 20 (2), 198-202
- https://doi.org/10.1097/bor.0b013e3282f4eff5
Abstract
The purpose of this review is to discuss the defining characteristics of refractory gout and the pharmacological management of this problem. Refractory gout refers to those patients who have ongoing symptoms of active disease and cannot maintain a target serum urate less than 6 mg/dl. Patients with refractory gout have reduced quality of life, functional impairment, and joint destruction. Multiple factors contribute to refractory gout, and they often relate to delayed or insufficient dosing with allopurinol. Chronic kidney disease imparts a dose limitation on allopurinol that further impairs the effectiveness of urate-lowering therapy. Febuxostat, a novel xanthine oxidase inhibitor, represents a potential alternative to allopurinol in refractory gout patients. Uricase, the enzyme that catalyzes conversion of uric acid into allantoin, is showing promise with its ability to rapidly diminish serum urate levels. The recently defined role of the NALP3 inflammasome in the inflammatory phase of gout suggests a potential role for interleukin-1 inhibition in urate crystal-induced inflammation. Refractory gout occurs when urate levels are not adequately controlled. Emerging therapies may improve the clinical course of patients with recalcitrant disease.Keywords
This publication has 32 references indexed in Scilit:
- A pilot study of IL-1 inhibition by anakinra in acute goutArthritis Research & Therapy, 2007
- Pharmacokinetics and pharmacodynamics of intravenous PEGylated recombinant mammalian urate oxidase in patients with refractory goutArthritis & Rheumatism, 2007
- Gout: new insights into an old diseaseJCI Insight, 2006
- IL1RN genotype as a risk factor for joint pain in hereditary haemochromatosis?Annals Of The Rheumatic Diseases, 2006
- Human parvovirus B19 viraemia is associated with neither IgM positivity nor anaemia in patients with rheumatic diseasesAnnals Of The Rheumatic Diseases, 2006
- Febuxostat Compared with Allopurinol in Patients with Hyperuricemia and GoutNew England Journal of Medicine, 2005
- Winners of the 2004 American College of Rheumatology Annual Slide CompetitionArthritis & Rheumatism, 2005
- Severe gouty arthritis refractory to anti-inflammatory drugs: treatment with anti-tumour necrosis factor as a new therapeutic optionAnnals Of The Rheumatic Diseases, 2004
- Long-term remission from gout associated with fenofibrate therapyClinical Rheumatology, 2003
- Severe Hypersensitivity Reactions to AllopurinolSouthern Medical Journal, 1979