From the Guidelines
Gout disease complications can be effectively managed and prevented by maintaining uric acid levels below 6 mg/dL through medications and lifestyle modifications, as recommended by the 2016 updated EULAR evidence-based recommendations for the management of gout 1.
Key Complications of Gout
- Development of tophi, which are hard nodules of uric acid crystals that form under the skin, typically around joints, earlobes, and other tissues
- Chronic gout leading to erosive arthritis with joint destruction and disability
- Kidney complications, including kidney stones and urate nephropathy
- Cardiovascular complications, such as hypertension, heart attack, and stroke
- Psychological impacts like depression and anxiety due to pain and disability
Prevention and Management
- Medications like allopurinol or febuxostat to maintain uric acid levels below 6 mg/dL 1
- Lifestyle modifications, including:
- Weight loss if appropriate
- Avoidance of alcohol (especially beer and spirits) and sugar-sweetened drinks
- Low-fat dairy products
- Regular exercise
- Avoidance of heavy meals and excessive intake of meat and seafood
- Regular medical follow-ups to monitor uric acid levels and adjust treatment as needed 1
Importance of Early Treatment
Early treatment of gout is crucial to prevent long-term complications and improve quality of life 1. Patients should be educated to self-medicate at the first warning symptoms of an acute flare, and prophylaxis against flares should be considered during the first 6 months of urate-lowering therapy 1.
From the FDA Drug Label
Gout is a metabolic disorder which is characterized by hyperuricemia and resultant deposition of monosodium urate in the tissues, particularly the joints and kidneys. The main complications of gout disease include:
- Joint damage: deposition of monosodium urate in the joints
- Kidney damage: deposition of monosodium urate in the kidneys
- Tophaceous gout: formation of urate crystals in the tissues
- Gout flares: sudden and severe attacks of pain and inflammation in the joints
- Nephrolithiasis: formation of kidney stones due to high levels of uric acid in the urine
- Renal colic: severe pain in the side or back due to kidney stones These complications can be managed with treatment, such as medication to lower uric acid levels and prevent gout flares 2.
From the Research
Gout Disease Complications
Gout is a common form of acute inflammatory arthritis caused by the deposition of monosodium urate crystals within the synovium of joints, leading to severe pain and reducing the quality of life for patients with this condition 3. The disease can lead to various complications, including:
- Painful flares and tophaceous deposits, which are debilitating and reduce the quality of life 4
- Chronic kidney disease, which can increase in incidence if urate-lowering therapy (ULT) is not initiated promptly 5
- Cardiovascular safety issues, as seen with the use of febuxostat, which has received a U.S. FDA black box warning 4
Treatment and Management
The treatment of gout involves both the management of acute flares and urate-lowering therapy to prevent future flares. Standard pharmacotherapies for gout flares include:
- Colchicine
- NSAIDs
- Oral or intramuscular corticosteroids
- IL-1 inhibitors, which are newly established as an option for flare refractory to standard therapies 3 Urate-lowering therapies aim to prevent gout flares, with an emphasis on a treat-to-target strategy, and include:
- Allopurinol
- Febuxostat
- Uricosuric agents, such as probenecid, sulfinpyrazone, and benzbromarone 3, 4
Efficacy and Safety of Urate-Lowering Therapies
Studies have compared the efficacy and safety of different urate-lowering therapies, including:
- Febuxostat, which was found to be superior to allopurinol and well-tolerated for urate reduction 6
- Lesinurad, which was found to be effective in combination with febuxostat or allopurinol, but may have a high risk of adverse events 6
- Allopurinol, which was found to be effective in achieving target serum urate levels, especially when initiated promptly after an acute attack 5, 7
Factors Associated with Achieving Target Serum Urate Levels
Several factors have been associated with achieving target serum urate levels, including: