| Updates in the management of gouty arthritis |
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In-Ah Choi, Seung-Jae Hong |
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| 통풍 관절염 치료의 최신지견 |
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최인아 &#; 홍승재, Seung-Jae Hong |
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| Abstract |
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Gout is the most common inflammatory arthritis in men over 40 years old and the prevalence is increasing.
Asymptomatic hyperuricemia is predisposing condition of gout but the frequency of progression to acute gout is not high
enough to need prophylactic treatment. In acute gout flare, first line therapy is non-steroid anti-inflammatory agents
(NSAIDs) or corticosteroids, depending on comorbidities. Colchicine is now second line therapy. Urate lowering therapy
for gout needs to be initiated when the second attack occurs in a year. Allopurinol, a xanthine oxidase inhibitor, has been
the most widely used agent for the treatment of chronic gout. Now, febuxostat has emerged as a new xanthine oxidase
inhibitor that is expected to be useful in patients with mildly decreased renal function. Uricosuric agents are alternative
therapies for patients with preserved renal function and no history of nephrolithiasis. During urate lowering therapy, the
dose should be titrated upward until the serum uric acid level is kept less than 6mg/dL. When initiating urate lowering
therapy, concurrent prophylactic therapy with NSAIDs or low dose colchicine for more than six months is recommended
for reducing flare-ups. In chronic gout treatment, dietary modification seems to have minimal effect, but alcohol drinking
and weight control can be recommended. (Korean J Med 76:151-162, 2009) |
| Key Words:
Gout; Gouty arthritis; Hyperuricemia; Treatment |
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