Diagnosis, treatment and comorbidity of gout
Gout is a kind of inflammatory arthritis causing a sudden burning pain, stiffness, and swelling in a joint, mainly the big toe. It occurs due to the increased levels of uric acid in the blood. Gout has many stages. Asymptomatic hyperuricemia depicts the interval prior to the first gout attack.
Acute gout, or a gout attack is, when something causes uric acid levels to spike or jostles the crystals that have formed in a joint, triggering the attack. Thus, inflammation causes pain which usually strike at night and intensify over the next eight to 12 hours.
Interval gout: It is the time between the attacks. Low-level inflammation may be damaging joints. Gout management should start via lifestyle changes and medication, so as to prevent future attacks or chronic gout. Chronic gout: In this state, uric acid levels remain high over a number of years. Attacks become common and the pain may not go away as it used to. With efficient management and treatment, this stage is preventable.
As per the update, musculoskeletal ultrasound and dual-energy-CT (DECT) findings are increasingly relevant for the establishment of the diagnosis of gout, and are therefore incorporated into the novel ACR/EULAR classification criteria. In 2013, canakinumab has been approved which is a monoclonal antibody directed against interleukin-1β (IL-1β) for the treatment of acute gout and for prophylaxis of flares. In patients revealing an inadequate response upon treatment with allopurinol or febuxostat, combination therapy with lesinurad might lessen uric acid levels to the target of < 6 mg/dl (< 5 mg/dl in tophaceous gout). Rapid lowering of uric acid levels and effective tophi reduction can be acquired with pegloticase, which can be utilized in selected patients with contraindications to xanthine oxidase inhibitors and uricosuric drugs. This article condenses the current scientific aspects of diagnosis, treatment and comorbidities of gout in the context of clinical relevance.