Comprehensive Medical Management of Gout

Gout is a disorder of uric acid metabolism and represents a heterogeneous group of diseases that include, an elevated serum urate concentration (hyperuricemia); recurrent attacks of acute arthritis in which monosodium urate monohydrate crystals are seen in synovial fluid leukocytes; aggregates of sodium urate monohydrate crystals (tophi) are deposited chiefly in and around joints which sometimes leads to deformity and crippling; renal disease involving glomerular, tublar, interstinal tissue and blood vessels as well as uric acid nephrolithiasis.Hyperuricemia1 refers to an elevated level of urate in the blood greater than 7mg/dl in males and >6.5mg/dl in females. Epidemiology Epidemiologic investigations suggest that gout frequency is on the rise worldwide . The incidence of gout varies in population with an overall prevalence of less than 1 to 15.3%. The prevalence increases substantially with age and increasing serum urate levels. For values greater than 9mg/dl the cumulative incidence of gout reaches 22% after 5 years . Gout affects more than 1% of adults in the western countries . Male: female ratio ranging from 7:1 to 9:1 .In ages younger than 65, men have 4 times higher prevalence than women (4:1 ratio), but in the older age groups (> 65), the gender gap narrows to 1 woman to every 3 men with gout and/ or hyperuricemia (3:1 ratio) . The Bhigwan COPCORD survey demonstrated low prevalence of Gout (0.12%) in rural India . In another Indian study gout prevalence of 2% was recorded .One of our own study from Jammu recorded 241.6/1000 prevalence of rheumatic disease and only two case of gout were reported .Hyperuricemia is fairly common, with a prevalence ranging from 2.3 to 41.4% in various populations. The prevalence for men is 13.6 cases per 1000 men, and the prevalence for women is 6.4 cases per 1000 women. This difference is largely a manifestation of age of onset because estrogenic hormones have a mild uricosuric effect; therefore, gout is unusual in premenopausal women. Pathogenesis of Gout [9, 10, 11] A weak organic acid with a pKa1 of 5.75, uric acid is the final product of human purine metabolism. At the Abstract Recent advances in understanding and medical treatment of gout have helped to reduce morbidity and mortality in patients suffering from this disease. A comprehensive care including identification and treatment of co-morbid conditions is equally important in management of gout. Aggressive treatment of acute attack of gout and judicious treatment of symptomatic chronic hyperuricemia with life style & dietary management and education of patients is of utmost importance. Present understanding of pathophysiology of gout has given a lead to identify a range of targets for pharmacotherapy and thus holds future promises for the development of new drugs and biologic agents for reversing refractory hyperuricemia and gout.