Managing Your Patient with Gout: A Review of Treatment Options

Abstract

Gout is an inflammatory arthritis that typically presents as acute onset, recurrent, monoarticular pain. In most patients, management of pain, risk assessment for future flares, and disability is not optimal and diagnostic and management approaches are applied inconsistently. Obtaining an accurate patient history, including comorbidities, concomitant medications, and familial history, is important for optimal results. Recognizing the acute flare in the patient at risk and establishing a definitive diagnosis of gout should be conducted promptly. Therapeutic options appropriate for treating the acute flare include colchicine, nonsteroidal anti-inflammatory drugs, and corticosteroids. After flare remission, prophylaxis with a flare prevention medication, such as colchicine, should be administered followed by initiation of urate-lowering therapy with allopurinol or febuxostat. Patient education, especially counseling on risk factors and contributors to hyperuricemia and gout, can improve the likelihood of successful therapy for this often suboptimally managed disease.

Deciphering the molecular mechanisms of anti-tubulin plant derived drugs

“…It binds on the b-tubulin subunit at the intradimeric interface of the heterodimer (Ravelli et al 2004) rendering it unable to form microtubules. However, since colchicine causes severe toxicity at the doses required for anticancer effects, it is used at much lower doses for other therapeutic purposes, such as therapy for gout (Doghramji 2011) and familial Mediterranean fever (Cabili et al 1985). Nevertheless, numerous plant derived colchicine analogs are currently under investigation for their potential anti-cancer applications, such as combretastatin A-4 (CA4), isolated first from Combretum caffrum, an Eastern Cape South African Bush Willow tree (Pettit et al 1987) which is undergoing clinical and preclinical trials as a vascular-targeting drug.…”

Bioassay-Guided Isolation and Identification of Xanthine Oxidase Inhibitory Constituents from the Leaves of Perilla frutescens

“…This drug has been used clinically for more than 40 years. Unfortunately, severe adverse effects in some patients, including fever, skin rashes, allergic reactions, hepatitis, and nephropathy limit the clinical use of allopurinol [6]. For this reason, xanthine oxidase inhibitors from natural products have been explored as viable, harmless, and nontoxic alternatives for the treatment of hyperuricemia [7,8,9].…”

Prophylaxis of Acute Arthritis at Initiation of Urate-Lowering Therapy in Gout Patients

“…At present, there are no works which could determine the optimal dose or duration of NSAIDs treatment for prophylaxis of acute gout arthritis [37].…”