Special Issue "Pharmacological Treatment for Gout"
Deadline for manuscript submissions: 31 January 2024 | Viewed by 1401
Interests: clinical pharmacology; quality use of medicines; gout; pharmacogenomics; pharmacometrics; adherence
Gout is the most common form of inflammatory arthritis in men and has a prevalence of 1-4% globally. The incidence of gout is rising worldwide, including in both developing and, more dramatically, in developed nations. Gout is caused by the deposition of urate crystals. Treatment for acute gout flares focuses on alleviating the pain due to the intense inflammation and includes short courses of nonsteroidal anti-inflammatory drugs (NSAIDs), colchicine or glucocorticosteroids. Treatment of chronic gout centres on preventing gout flares and promoting the dissolution of tophi (urate deposits, if present) with urate-lowering therapy (ULT). The goal of ULT is to eliminate gout flares by reducing serum urate (SU) concentrations to ≤0.36 mmol/L (or <0.30 mmol/L if tophi are present). These targets are below the saturation point for SU (0.42 mmol/L), making the crystallisation and deposition of urate in the form of monosodium urate in joints less likely. Life-long treatment with ULT is recommended. Co-prescription of low-dose colchicine or NSAIDs for 6 months on initiation of ULT is recommended to prevent a paradoxical increase in gout flares related to sudden ULT-induced reduction in SU. Available ULTs include xanthine oxidoreductase inhibitors (allopurinol, febuxostat) and uricosuric agents (probenecid). Of these treatments, allopurinol is overwhelmingly the most common ULT prescribed. Despite the availability of effective and generally tolerable preventative treatments for gout, inadequate dosages and poor rates of persistence with ULT treatment regimens are prominent barriers to successful management. In the last decade, substantial efforts have been made to educate prescribers about titrating doses of ULT to reach target SU concentrations, rather than selecting a dose based on, and limited by, renal function, a historical approach dictated by concerns around toxicity. However, interventions to encourage dosing ULT to target SU concentrations have been very limited in their effect. Adherence to ULT was, on average, only 46.0% (95% confidence interval (CI) 40.8-51.2) in a recent meta-analysis. These data are consistent across the United States, the United Kingdom, Korea, Ireland, Israel and New Zealand.
Authors are invited to submit original and review articles on quantitative and qualitative research contributing to the understanding of the current state of gout treatment, to be published in this Special Issue of Pharmaceuticals. The proposed topics cover factors contributing to a suboptimal response to gout treatment, novel approaches to treating gout and interventions to improve gout management.
We look forward to your valuable contribution.
Dr. Sophie Stocker
Dr. Daniel F. B. Wright
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