Pharmacotherapy

pillsReducing pain and inflammation are the main goals of treating gout. First-line treatments for gout included non-steroidal anti-inflammatory drugs, colchicine, or corticosteroids. While there are other drugs that are currently the subject of clinical trials, that have the potential to increase options for those with hard to treat gout.

Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)

NSAIDs such as ibuprofen, naproxen, indomethacin, and celecoxib are commonly used to treat pain and inflammation associated with a gout attack. These drugs usually have the best effect when they are started early in the gout attack, when they can have significant anti-inflammatory activity, in addition to pain relief.

Corticosteroids

Oral corticosteroids, such as prednisone, prednisolone, and methylprednisolone can also be used in the treatment of gout, either via injection, or orally. Corticosteroids have been shown to be effective in the treatment of gout in several clinical trials.

Colchicine

Generally used as a preventive medicine, colchicine is given to reduce the frequency of gout attacks.

Xanthine Oxidase Inhibitors

Xanthine oxidase inhibitors, such as allopurinol and Febuxostat, act to reduce the levels of uric acid that are produced. Initiating treatment with one of these drugs can sometimes cause a gout attack, which is why they are usually initially prescribed with colchicine.

Urate-Lowering Drugs

Urate-lowering drugs such as sulfinpyrazone, benzbromarone, and probenecid act by promoting more urate to be flushed via the kidneys, thus reducing the amount of urate present in the body.

Interleukin-1 (IL-1) Inhibitors

A relatively new class of drugs for treating gout include the IL-1 inhibitors such as rilonacept, anakinra, and canakinumab. IL-1 inhibitors may be useful for treating patients who are either unable to take other therapies, or who have not responded well to other forms of treatment. IL-1 inhibitors act by inhibiting the pro-inflammatory effects of IL-1, and thus acts as anti-inflammatory drugs. This class of drugs are still under clinical investigation in the treatment of gout. Studies supporting the use of anakinra are limited, although positive, while canakinumab has been found to have high toxicity. Rilonacept is a promising new drug, however is still the subject of clinical trials.

 

 

 

 

References:

Neogi. Gout N Engl J Med, 364 (2011), pp. 443–452.

T.T. Cheng, H.M. Lai, C.K. Chiu, Y.C. Chem. A single-blind, randomized, controlled trial to assess the efficacy and tolerability of rofecoxib, diclofenac sodium, and –meloxicam in patients with acute gouty arthritis Clin Ther, 26 (2004), pp. 399–406

Terkeltaub, R. Clinical practice gout N Engl J Med, 349 (2003), pp. 1647–1655

Khanna, P.P, Gladue, H.S, Singh, M.K, FitzGerald, J.D, Bae, S, Prakash, S, Kaldas, M, Gogia, M, Berrocal, V, Townsend, W, Terkeltaub, R, Khanna, D. Treatment of acute gout: A systematic review. Seminars in Arthritis and Rheumatism, Volume 44, Issue 1, August 2014, Pages 31–38

Tran, T.H, Pham, J.T, Shafeeq, H, Manigault, K.R, Arya, V. Role of Interleukin-1 Inhibitors in the Management of Gout Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy Volume 33, Issue 7, pages 744–753, July 2013