Current and Emerging Therapies for Gout

Gout is the most common inflammatory arthropathy in the western world. It affects millions yearly and accounts for significant disability, lost wages, and increased health care costs. Despite it being a very “curable” disease, it continues to be inadequately treated and many times underestimated as a contributor to the overall disease state. Controlling the acute flares has been historically the priority in the management of gout. Approved therapies to treat acute flares have limitations, especially with gout patients who frequently have multiple comorbidities. Over the last decade, there has been a better understanding that just focusing on the treatment of acute flares, although important, may result in inadequate control of hyperuricemia, resulting in a significant urate burden, chronic arthropathy, and significant disability. Successfully treating gout involves a multi-pronged approach: first, by controlling flares with prophylactic anti-inflammatory medications such as colchicine and non-steroidals and secondly, by treating to target, lowering the serum urate level below 6 mg/dL (and in some cases <5, <4, or even less than 3 mg/dL is necessary) with uricostatic medications alone or in combination with uricosurics. A greater understanding of the pathophysiology of gout has resulted in the discovery of new therapies to treat and prevent gout flares and underlying hyperuricemia. Novel therapies that lower serum urate levels or treat and prevent acute gouty flares can not only directly improve the care of gout patients but they can also provide the springboard for discourse and the edification of those who treat and those who are treated for this underestimated disease.