Pharmacotherapy of Gout & Hyperuricemia

Introduction

• Gout — A metabolic disorder of recurrent acute arthritis caused by deposition of monosodium urate (MSU) crystals in joints and cartilage, with tophi, uric-acid renal calculi and interstitial nephritis as further manifestations; classic presentation is painful distal monoarthritis.
• Hyperuricaemia — The biochemical prerequisite — plasma urate near its limit of solubility (~5 mg/dL solubility threshold in G&G; KDT quotes a 2–6 mg/dL reference range). It is necessary but not sufficient — most hyperuricaemic individuals never develop a crystal event.
• Burden & risk factors — Affects ~3% of Western adults; risk rises with male sex, diuretics, alcohol, obesity, hypertension, sweetened beverages, red meat and seafood. Adverse cardiovascular outcomes are increasingly associated.