Gout: New Treatment for an Old Disease

Gout is a common chronic arthritis that can lead to significant disability. Gout has a known cause and can normally be cured with appropriate therapy. Hypouricaemic agents reduce uric acid concentrations by inhibiting uric acid production (allopurinol) or enhancing uric acid excretion (probenecid, benzbromarone). Allopurinol is the most commonly used hypouricaemic agent, but at recommended doses often fails to adequately reduce uric acid concen-trations and prevent acute attacks of gout. The use of probenecid is limited due to the lack of efficacy in renal impairment. In the last few years, new agents in the management of hyperuricaemia and gout have emerged. Febuxostat, a xanthine oxidase inhibitor, is an effective hypouricaemic agent although it is not yet available. Rasburicase, a recombinant uricase (which catalyses the conversion of uric acid to the more readily excreted allantoin) is available for prevention of tumour lysis syndrome. However, its repeated use, as would be required in chronic gout, is limited by antigenicity. With the use of anakinra a new therapeutic principle has emerged and, if proven in further studies, could be used as a promising agent in patients where glucocorticoids or NSAIDs are contraindicated or even as a first-line therapy.