Chronic gout: a review of approaches to treatment

Abstract

Gout is an inflammatory disorder characterised by joint immobility due to monosodium urate crystals deposits. The prevalence of gout is increasing owing to several factors, including dietary patterns, cardiometabolic disorders, and certain medications, amongst others. Central to gout pathophysiology is the accumulation of uric acid, which subsequently forms monosodium urate crystals, which can deposit in joints, forming tophi and instigating the inflammatory process and pain. The diagnosis and monitoring of gout include synovial aspiration, imaging tools, and plasma uric acid measurement. Nevertheless, some of the detection tools present several drawbacks, therefore necessitating innovative developments towards detection and monitoring approaches. From a therapeutic standpoint, the goal is to relieve pain and inflammation and maintain desired plasma uric acid levels. Therefore, the pharmacological interventions include a variety of modalities such as NSAIDs, corticosteroids, xanthine oxidase inhibitors, and drugs aiming to promote renal excretion of uric acid. Despite the availability of these treatment approaches, however, gout management remains a challenge, necessitating strategic innovative approaches. A heightened understanding of uric acid metabolism presents opportunities for visualisation and development of efficacious treatment approaches for gout. Furthermore, use of technological advancements in drug formulation strategies, such as nanoparticles, can offer additional avenues to improve gout management. The incorporation of pharmacogenetics is envisaged to also improve the prognosis of gout, through strides aiming to personalise gout management. Lastly, improved patient education on gout management can yield positive outcomes.