Prophylaxis for Acute Gout Flares After Therapy
This review summarizes evidence relating to prophylaxis for gout flares after the initiation of urate-lowering therapy (ULT). We searched MEDLINE via PubMed for articles published in English from 1963 to 2013 using MEsH terms covering all aspects of prophylaxis for flares. Dispersion of monosodium urate crystals during the initial phase of deposit dissolution with ULT exposes the patient to an increased rate of acute flares that could contribute to poor treatment adherence. Slow titration of ULT might decrease the risk of flares. According to the most recent international recommendation, the two first-line options for prophylaxis are low-dose colchicine (0.5 mg once or twice a day) or low-dose NSAIDs such as naproxen 250 mg orally twice a day. They can be given for up to 6 months. If these drugs are contraindicated, not tolerated or ineffective, low-dose corticosteroids (prednisone or prednisolone) might be used. Recently, reports for four trials described the efficacy of canakinumab and rilonacept, two IL-1 inhibitors, for preventing flares during the initiation of allopurinol therapy. Prophylaxis for flares induced by ULT is an important consideration in gout management. Low-dose colchicine and low-dose NSAIDs are the recommended first-line therapies. Although no IL-1 blockers are approved as prophylactic treatment, this class of drug could become an interesting option for patients with gout with intolerance or contraindication to colchicine, NSAIDs or corticosteroids.
Gout is an inflammatory arthritis caused by deposition in the joints of monosodium urate (MSU) crystals that result from chronic hyperuricaemia. It is the most prevalent form of arthritis in adult males, and the worldwide incidence and prevalence are steadily increasing. MSU crystal deposition in joints may be responsible for painful acute gout flares (GFs). Recurrent flares are associated with high socio-economic burden due to the frequent use of health care and impaired work productivity. In addition, gout not properly treated can cause joint destruction and permanent disability. Long-term treatment of gout aims to reduce the urate level below the limit of MSU solubility, thus dissolving MSU crystal deposits and leading to the disappearance of gout features. International guidelines recommend urate-lowering treatment (ULT) targets of <300–360 μmol/l (5–6 mg/dl) urate.
However, the dispersion of MSU crystals during the initial phase of deposit dissolution exposes the patient to an increased rate of acute flares that could contribute to poor treatment adherence. Therefore prophylaxis for these ULT-induced flares is an important consideration in gout management. This article reviews available data on gout prophylaxis, with an emphasis on randomized controlled trials (RCTs) that examined the efficacy of prophylactic treatments after the initiation of ULT.
Abstract and Introduction
Abstract
This review summarizes evidence relating to prophylaxis for gout flares after the initiation of urate-lowering therapy (ULT). We searched MEDLINE via PubMed for articles published in English from 1963 to 2013 using MEsH terms covering all aspects of prophylaxis for flares. Dispersion of monosodium urate crystals during the initial phase of deposit dissolution with ULT exposes the patient to an increased rate of acute flares that could contribute to poor treatment adherence. Slow titration of ULT might decrease the risk of flares. According to the most recent international recommendation, the two first-line options for prophylaxis are low-dose colchicine (0.5 mg once or twice a day) or low-dose NSAIDs such as naproxen 250 mg orally twice a day. They can be given for up to 6 months. If these drugs are contraindicated, not tolerated or ineffective, low-dose corticosteroids (prednisone or prednisolone) might be used. Recently, reports for four trials described the efficacy of canakinumab and rilonacept, two IL-1 inhibitors, for preventing flares during the initiation of allopurinol therapy. Prophylaxis for flares induced by ULT is an important consideration in gout management. Low-dose colchicine and low-dose NSAIDs are the recommended first-line therapies. Although no IL-1 blockers are approved as prophylactic treatment, this class of drug could become an interesting option for patients with gout with intolerance or contraindication to colchicine, NSAIDs or corticosteroids.
Introduction
Gout is an inflammatory arthritis caused by deposition in the joints of monosodium urate (MSU) crystals that result from chronic hyperuricaemia. It is the most prevalent form of arthritis in adult males, and the worldwide incidence and prevalence are steadily increasing. MSU crystal deposition in joints may be responsible for painful acute gout flares (GFs). Recurrent flares are associated with high socio-economic burden due to the frequent use of health care and impaired work productivity. In addition, gout not properly treated can cause joint destruction and permanent disability. Long-term treatment of gout aims to reduce the urate level below the limit of MSU solubility, thus dissolving MSU crystal deposits and leading to the disappearance of gout features. International guidelines recommend urate-lowering treatment (ULT) targets of <300–360 μmol/l (5–6 mg/dl) urate.
However, the dispersion of MSU crystals during the initial phase of deposit dissolution exposes the patient to an increased rate of acute flares that could contribute to poor treatment adherence. Therefore prophylaxis for these ULT-induced flares is an important consideration in gout management. This article reviews available data on gout prophylaxis, with an emphasis on randomized controlled trials (RCTs) that examined the efficacy of prophylactic treatments after the initiation of ULT.
Source...