Gout is one of the most common types of arthritis which causes intense swelling, pain, and stiffness in a joint. A gout attack can occur ever so suddenly and can awaken you in the dead of the night with feeling like your big toe is on fire. The affected joints will be hot, tender and very swollen that even the weight of your bed sheet may seem intolerable.
Gout attacks can come quickly and will keep on returning every single time which slowly harms the tissue in the inflamed region. Gout is also associated with an increased incidence of metabolic and cardiovascular disease.
Gouts can be very tricky to diagnose. This is because its symptoms are quite similar to those of other conditions. However, medical science continues to find new ways of diagnosing and managing gout.
New Views and Imaging for Gout Diagnosis
With a better understanding of the pathophysiology of gout combined with the latest advancements in technology, new and better non-invasive tools were discovered in facilitating the diagnosis and management of gout.
The use of ultrasound technology and DECT or dual-energy computed tomography is contributing massively to the improvements of gout study, diagnosis, and management. DECT provides an accurate quantification of MSU or monosodium urate crystals that aggregates both soft tissues and joints.
Overall, the evidence for the new imaging techniques looks promising, however, its availability and cost, as well as the current lack of standardization, argue against its usage in routine clinical practice at the moment.
New Treatments For Acute Attacks
The field of gout treatments came to a standstill in the latter half of the 20th century when there are no new drugs that were approved for clinical use.
Non-steroid anti-inflammatory drugs, glucocorticoids (intra-articular, intramuscular and oral), low-dose colchicines are all effective therapeutic choices for the management of acute gout.
If used, a colchicine taken in low-dose (1mg, 0.5 mg an hour later) is as effective as traditional higher dose therapy with fewer adverse effects. Novel agents such as interleukin-1 beta, canakinumab, and anakinra have been investigated, however, still not a part of the standard management for acute gout.
Because hyperuricemia is the root condition which promotes gout, a long-term treatment of gout always involved a therapeutic lowering of tissue and serum UA levels. Here are new ULTs that are finding their way to pharmacopeia.
It is a recombinant, pegylated uricase which degrades uric acid. It was approved in the year 2012 by the FDA and is indicated for the treatment of hyperuricemia in adults with tophaceous or chronic gout refractory to conventional ULT. The pegloticase is administered every 2 weeks intravenously. Studies have confirmed pegloticase has the ability to rapidly and dramatically lower sUA.
It is a selective and highly potent uric acid re-absorption inhibitor. It reduces sUA by inhibiting both the organic anion transporter 4 and the sUA-anion exchanger transporter 1 which are involved in UA re-absorption across the renal proximal tubule. Lesinurad is much more potent when compared to the older uricosuric probenecid and remains effective even in moderate renal insufficiency. Lesinurad gained an FDA approval in the year 2015 to be a second-line treatment for gout patients who failed to meet the target sUA in spite of treatment with a traditional XOI ULT which is febuxostat or allopurinol.
It is a pipeline drug with a dual action mechanism. Patients undergoing ULT are prescribed routinely by their doctors with concurrent anti-inflammatory prophylaxis in order to reduce the risk of gout attacks that is brought by the sUA-lowering process itself.
All gout medications were historically sUA-lowering or anti-inflammatory. Arhalofenate, in contrast, is a PPAR-γ or peroxisome proliferator-activated receptor gamma partial agonist which demonstrates dual anti-inflammatory and ULT effects.
With the most recent advancements of the researchers in understanding crystal inflammation and the pathophysiology of hyperuricemia, gout comes out as a disease that bears serious implications and needs new and effective therapies.
However, these advancements are still far from reaching every hospitals and gout treatment centers. It is therefore important that every individual do their best to prevent gout and to reduce the symptoms of gout with natural gout treatment.