Despite being used for decades as a primary treatment for acute gout, optimal colchicine dosing has not been systematically evaluated. This is potentially important, as higher doses of colchicine can frequently be associated with the undesired consequence of severe diarrhea and gastrointestinal distress.
Urate lowering therapy can be very effective for reducing flares of gout, thereby preventing ongoing joint damage and deformity. Despite this efficacy, most gout patients are undertreated, leading to undue painful flares and joint damage. Non-adherence to therapy is a strong contributor to undertreatment.
At their November 24, 2008 meeting, the FDA Arthritis Drug Advisory Committee heard updated efficacy and safety data for febuxostat for the treatment of gout-associated hyperuricemia. The committee’s recommendation was carried on a vote of 12 to 0. Final FDA approval of the drug is pending; however, FDA approval generally follows the recommendations of the advisory committee.
Elevated uric acid levels and the incidence of clinical gout are exceedingly rare in women before menopause but rise after cessation of menses, potentially explained by an effect of estrogen on the renal handling of uric acid. Despite this well established association, little is known about the effect of post-menopausal estrogen replacement on uric acid levels in women.
Chronic tophaceous gout remains difficult to treat with available medications. Replacement of uricase, an enzyme essential for uric acid metabolism yet functionally deficient in humans, represents a promising therapy for uric acid lowering and resolution of tophi. Rasburicase, an available recombinant form of uricase, is limited in its use for gout due to immunogenicity.