Best Practice & Research Clinical Rheumatology
Volume 20, Issue 4 , Pages 673-684 , August 2006

Gout: can we create an evidence-based systematic approach to diagnosis and management?

  • Lan X. Chen, MD, PhD (Clinical Assistant Professor at University of Pennsylvania)
  • H. Ralph Schumacher, MD (Professor of Medicine at University of Pennsylvania)

      Affiliations

    • Corresponding Author InformationCorresponding author. Address: VA Medical Center 151 K, University of Woodlands Avenue, Philadelphia, PA 19104 4283, USA. Tel.: +1 215 823 4244; Fax: +1 215 823 6032.

References 

  1. Choi HK, Mount DB, Reginato AM. Pathogenesis of gout. Annals of Internal Medicine. 2005;143:499–516
  2. Schumacher HR, Wortman RL. Monosodium urate crystal deposition arthropathy. Part I: Review of the stages and diagnosis of gout. Advanced Studies in Medicine. 2005;5:133–138
  3. Schumacher HR, Sieck MS, Rothfuss S, et al. Reproducibility of synovial fluid analyses: a study among 4 laboratories. Arthritis and Rheumatism. 1986;29:770–774
  4. Lumbreras B, Pascual E, Frasquet J, et al. Analysis for crystals in synovial fluid: training of the analysis results in high consistency. Annals of the Rheumatic Diseases. 2005;64:612–615
  5. Petrocelli A, Wang AL, Swezey RL. Identification of pathologic synovial fluid crystals on Gram stains. Journal of Clinical Rheumatology. 1998;4:103–105
  6. Chen LX, Schumacher HR. Current trends in crystal identification. Current Opinion in Rheumatology. 2006;18:171–173
  7. Becker MA, Schumacher HR, Wortmann RL, et al. Reduction in gout flares in subjects with chronic gout treated with febuxostat or allopurinol for 52 weeks. The FACT trial. Arthritis and Rheumatism. 2005;52(supplement):S108;(abstract)
  8. Grainger R, Harrison AA, Taylor WJ. Preliminary identification of potential items for a definition of a gout flare using Delphi methodology. Arthritis and Rheumatism. 2005;52(supplement):S105;(abstract)
  9. Wallace SL, Robinson H, Masi AT, et al. Preliminary criteria for the classification of the acute arthritis of primary gout. Arthritis and Rheumatism. 1972;20:895–900
  10. Schumacher HR, Edwards LN, Perez-Ruiz L, et al. OMERACT 7. Special interest group on outcome measures for acute and chronic gout. The Journal of Rheumatology. 2005;32:2452–2455
  11. Johnson RJ, Rideout BA. Uric acid and diet – insights into the epidemic of cardiovascular disease. The New England Journal of Medicine. 2004;350:1071–1073
  12. Freedman DS, Williamson DF, Gunter EW, Byers T. Relation of serum uric acid to mortality and ischemic heart disease: the NHANES I epidemiologic follow up study. American Journal of Epidemiology. 1995;141:637–644
  13. Baker JF, Krishnan E, Chen L, Schumacher HR. Serum uric acid and cardiovascular disease: recent developments, and where do they leave us?. The American Journal of Medicine. 2005;118:816–826
  14. Niskanen LK, Laaksonen DE, Nyyssonen K, et al. Uric acid level as a risk factor for cardiovascular and all-cause mortality in middle-aged men. Archives of Internal Medicine. 2004;164:1546–1551
  15. Hakoda M, Masunari N, Yamada M, et al. Serum uric acid concentration as a risk factor for cardiovascular mortality: a longterm cohort study of atomic bomb survivors. The Journal of Rheumatology. 2005;32:906–912
  16. The Anturane Trial Research Group. Sulfinpyrazone in the prevention of sudden death after myocardial infarction. The New England Journal of Medicine. 1980;302:250–256
  17. Sulfinpyrazone in post-myocardial infarction. Report form the Anturan Reinfarction Italian Study. Lancet. 1982;1:237–242
  18. Hoieggen A AM, Kjeldsen SE, Julius S, et al. The impact of serum uric acid on cardiovascular outcomes in the LIFE study. Kidney International. 2004;65:1041–1049
  19. Campion EW, Glynn RJ, De Labry LO. Asymptomatic hyperuricemia: risks and consequences in the Normative Aging Study. The American Journal of Medicine. 1987;82:421–426
  20. Fessel WJ. Renal outcomes of gout and hyperuricemia. The American Journal of Medicine. 1979;67:74–82
  21. Riedel AA, Nelson M, Wallace K, et al. Prevalence of comorbid conditions and prescription medication use among patients with gout and hyperuricemia in a managed care setting. Journal of Clinical Rheumatology. 2004;10:308–314
  22. Vázquez-Mellado J, Garcia CG, Vázquez SG, et al. Metabolic syndrome and ischemic heart disease in gout. Journal of Clinical Rheumatology. 2004;10:105–109
  23. Ahern MJ, Reid C, Gordon TP, et al. Does colchicine work? The results of the first controlled study in acute gout. Australian and New Zealand Journal of Medicine. 1987;17:301–304
  24. Schlesinger N, Schumacher HR. Gout. In:  Tugwell P,  Shea B editor. Evidence Based Rheumatology. London: BMJ Books; 2004;p. 65–95
  25. Pawlotsky Y. What is the optimal treatment for acute crystal-induced arthritis?. Revue du Rhumatisme English Ed. 1996;63:231–233
  26. Smyth CJ, Percy JS. Comparison of indomethacin and phenylbutazone in acute gout. Annals of the Rheumatic Diseases. 1973;32:351–353
  27. Ruosti A, Vainio U. Treatment of acute gouty arthritis with proquazone and indomethacin: a comparative double-blind trial. Scandinavian Journal of Rheumatology. 1978;21(supplement):15–17
  28. Altman RD, Honig S, Levin JM, et al. Ketoprofen versus indomethacin in patients with acute gouty arthritis: a multicenter, double blind comparative study. The Journal of Rheumatology. 1988;15:1422–1426
  29. Weiner GI, White SR, Weitzner RI, et al. Double blind study of phenoprofen versus phenylbutazone in acute gouty arthritis. Arthritis and Rheumatism. 1979;22:425–426
  30. Lederman R. A double-blind comparison of etodolac (Lodine) and high doses of naproxen in the treatment of acute gout. Advances in Therapy. 1990;7:344–354
  31. Shrestha M, Morgan DL, Moreden JM, et al. Randomized double-blind comparison of the analgesic efficacy of intramuscular ketorolac and oral indomethacin in the treatment of acute gouty arthritis. Annals of Emergency Medicine. 1995;26:682–686
  32. Maccagno A, Di Giorgio E, Romanowicz A. Effectiveness of etodolac (Lodine) compared with naproxen in patients with acute gout. Current Medical Research and Opinion. 1991;12:423–429
  33. Schumacher HR, Boice J, Daikh DI, et al. Randomized double-blind trial of etoricoxib and indomethacin in treatment of acute gouty arthritis. BMJ (Clinical Research Ed.). 2002;324:1488–1492
  34. Rubin BR, Burton R, Navarra S, et al. Efficacy and safety profile of treatment with etoricoxib 120mg once daily compared with indomethacin 50mg three times daily in acute gout. Arthritis and Rheumatism. 2004;50:598–606
  35. Cheng T, Lai H, Chiu C, Chen Y. A single-blind, randomized, controlled trial to assess the efficacy and tolerability of rofecoxib, diclofenac sodium, and meloxicam in patients with acute gouty arthritis. Clinical Therapeutics. 2004;26:399–406
  36. Groff GD, Franck WA, Raddatz DA. Systemic steroid therapy for acute gout: a clinical trial and review of the literature. Seminars in Arthritis and Rheumatism. 1990;19:329–336
  37. Fernandez C, Noguera R, Gonzalez JA, Pasquel E. Treatment of acute attacks of gout with small doses of intraarticular triamcinolone acetonide. The Journal of Rheumatology. 1999;26:2285–2286
  38. Spies TD, Stone RE. Relief of the symptoms of acute gout and rheumatoid arthritis by means of pituitary adrenocorticotropic hormone (ACTH). Southern Medical Journal. 1949;42:720–722
  39. Gutman AB, Yu TF. Effects of adrenocorticotropic hormone (ACTH) in gout. The American Journal of Medicine. 1950;9:24–30
  40. Ritter J, Kerr LD, Valerano-Marcet J, Spiera H. ACTH revisited: effective treatment for acute crystal induced synovitis in patients with multiple medical problems. The Journal of Rheumatology. 1994;21:696–699
  41. Alloway JA, Moriarty MJ, Hoogland YT, Nashel D. Comparison of triamcinolone acetonide with indomethacin in the treatment of acute gouty arthritis. The Journal of Rheumatology. 1993;20:111–113
  42. Siegel LB, Alloway JA, Nashel DJ. Comparison of adrenocorticotropic hormone and triamcinolone acetonide in the treatment of gouty arthritis. The Journal of Rheumatology. 1994;21:1325–1327
  43. Axelrod D, Preston S. Comparison of parenteral adrenocorticotropic hormone with oral indomethacin in the treatment of acute gout. Arthritis and Rheumatism. 1988;31:803–805
  44. Getting SI, Christian HC, Flower RJ, et al. Activation of melanocortin type 3 receptor as a molecular mechanism for adreno-corticotropic hormone efficacy in gouty arthritis. Arthritis and Rheumatism. 2002;46:2765–2775
  45. Dorwart BB, Hansell JR, Schumacher HR. Effects of cold and heat on urate crystal-induced synovitis in the dog. Arthritis and Rheumatism. 1974;17:563–572
  46. Schlesinger N, Baker DG, Beutler AM, et al. Local ice therapy during bouts of acute gouty arthritis. The Journal of Rheumatology. 2002;29:331–334
  47. Agudelo CA, Schumacher HR, Phelps P. Effect of exercise on urate crystal-induced inflammation in canine joints. Arthritis and Rheumatism. 1972;15:609–616
  48. Fraser RC, Davis RH, Walker FS. Comparative trial of azapropazone and indomethacin plus allopurinol in acute gout and hyperuricaemia. The Journal of the Royal College of General Practitioners. 1987;37:409–411
  49. Douglas G, Thompson M. A comparison of phenylbutazone and flufenamic acid in the treatment of acute gout. Annals of Physical Medicine. 1970;10:275–280
  50. Gutman A, Yu T. Protracted uricosuric therapy in tophaceous gout. Lancet. 1957;21:1258–1260
  51. Shoji A, Yamanaka H, Kamatani N. A retrospective study of the relationship between serum level and recurrent attacks of gouty arthritis: evidence for reduction of recurrent gouty arthritis with antihyperuricemic therapy. Arthritis and Rheumatism. 2004;51:321–325
  52. Yu TF, Gutman AB. Efficacy of colchicine prophylaxis in gout, prevention of recurrent gouty arthritis over a mean period of five years in 208 gouty subjects. Annals of Internal Medicine. 1961;55:179–192
  53. Li-Yu J, Clayburne G, Sieck M, et al. Treatment of chronic gout. Can we determinne when urates stores are depleted enough to prevent attacks of gout?. The Journal of Rheumatology. 2001;28:577–580
  54. Perez-Ruiz F, Calabozo M, Pijoan JI, et al. Effect of urate-lowering therapy on the velocity of size reduction of tophi in chronic gout. Arthritis and Rheumatism. 2002;47:356–360
  55. Wortmann RL, Schumacher HR, Becker MA, et al. Reduction in tophus size in subjects with chronic gout treated with febuxostat or allopurinol for 52 weeks – FACT trial. Arthritis and Rheumatism. 2005;52(supplement):S108;(abstract)
  56. Vogt B. Urate oxidase (rasburicase) for treatment of severe tophaceous gout. Nephrology, Dialysis, Transplantation: Official Publication of the European Dialysis and Transplant Association - European Renal Association. 2005;20:431–433
  57. Baraf HSB, Kim S, Matsumoto AK, Maroli AN. Resolution of tophi with intravenous Peg-uricase in refractory gout. Arthritis and Rheumatism. 2005;52(supplement):S105;(abstract)
  58. Bomalaski JS, Lluberas G, Schumacher HR. Monosodium urate crystals in the knee joints of patients with asymptomatic, nontophaceous gout. Arthritis and Rheumatism. 1986;29:1480–1484
  59. Perez-Ruiz F, Calabozo M, Fernandez-Lopez J, et al. Treatment of chronic gout in patients with renal function impairment. An open, randomized, actively controlled study. Journal of Clinical Rheumatology. 1999;5:49–55
  60. Yang W, Sarawate C, Griffith C, et al. Ability to attain target serum uric acid level in gout patients on allopurinol. Arthritis and Rheumatism. 2005;52(supplement):S410;(abstract)
  61. Reidel AA, Nelson M, Joseph-Ridge N, et al. Compliance with allopurinol therapy among managed care enrollees with gout: a retrospective analysis of administrative claims. The Journal of Rheumatology. 2004;31:1575–1581
  62. Hande KR, Noone RM, Stone WJ. Severe allopurinol toxicity. Description and guidelines for prevention in patients with renal insufficiency. The American Journal of Medicine. 1984;76:47–55
  63. Ferraz MB, O'Brien B. A cost effectiveness analysis of urate lowering drugs in nontophaceous recurrent gouty arthritis. The Journal of Rheumatology. 1995;22:908–914
  64. Sarawate C, Patel P, Brewer KK, et al. Impact of serum uric acid on risk of acute gout attacks. Arthritis and Rheumatism. 2005;52:S106;(abstract)
  65. Loebl WY, Scott JT. Withdrawal of allopurinol in patients with gout. Annals of the Rheumatic Diseases. 1974;33:304–307
  66. Van Lieshout-Zuidema MF, Breedveld FC. Withdrawal of longterm antihyperuricemic therapy in tophaceous gout. The Journal of Rheumatology. 1993;20:1383–1385
  67. Gast LF. Withdrawal on longterm antihyperuricemic therapy in tophaceous gout. Clinical Rheumatology. 1987;6:70–73
  68. Borstad GC, Bryant LR, Abel MP, et al. Colchicine for prophylaxis of acute flares when initiating allopurinol for chronic gouty arthritis. The Journal of Rheumatology. 2004;31:2429–2432
  69. Choi HK. Diet, alcohol and gout: how do we advise patients given recent developments. Current Rheumatology Reports. 2005;7:220–226
  70. Choi HK, Curhan G. Beer, liquor, and wine consumption and serum uric acid level: the third national health and nutrition examination survey. Arthritis and Rheumatism. 2004;51:1023–1029
  71. Fam AG. Gout: excess calories, purines, and alcohol intake and beyond. Response to a urate-lowering diet. The Journal of Rheumatology. 2005;32:773–777
  72. Dessein PH, Shipton EA, Stanwix AE, et al. Beneficial effects of weight loss associated with moderate calorie/carbohydrate restriction, and proportional intake of protein and unsaturated fat on serum urate and lipoprotein levels in gout: a pilot study. Annals of the Rheumatic Diseases. 2000;59:539–543
  73. Tate GA, Mandell BF, Karmali RA, et al. Suppression of monosodium urate crystal-induced acute inflammation by diets enriched with gamma-linolenic acid and eicosapentaenoic acid. Arthritis and Rheumatism. 1988;31:1543–1551
  74. Huang H-Y, Appel LJ, Choi MJ, et al. The effects of vitamin C supplementation on serum concentrations of uric acid: results of a randomized controlled trial. Arthritis and Rheumatism. 2005;52:1843–1847
  75. Jacob RA, Spinozzi GM, Simon VA, et al. Consumption of cherries lowers serum urate in healthy women. The Journal of Nutrition. 2003;133:1826–1829
  76. Unno T, Sugimoto A, Kakuda T. Xanthine oxidase inhibitors from the leaves of Lagerstroemia speciosa (L.) Pers. Journal of Ethnopharmacology. 2004;93:391–395
  77. Owen PL, Johns T. Xanthine oxidase inhibitory activity of northeastern North American plant remedies used for gout. Journal of Ethnopharmacology. 1999;64:149–160
  78. Murphy-Bielicki B, Schumacher HR. How does patient education affect gout?. Clinical Rheumatology Practice. 1984;2:77–80
  79. Macfarlane DG, Dieppe PA. Diuretic-induced gout in elderly women. British Journal of Rheumatology. 1985;24:155–157
  80. Louthrenoo W, Kasitanon N, Wichainun R, Sukitawut W. Effect of minidose aspirin on renal function and renal uric acid handing in healthy young adults. Journal of Clinical Rheumatology. 2002;8:299–304
  81. Wurzner G, Gerster JC, Chiolero A, et al. Comparative effects of losartan and irbesartan on serum uric acid in hypertensive patients with hyperuricaema and gout. Journal of Hypertension. 2001;19:1855–1860
  82. Soffer BA, Wright JT, Pratt JH, et al. Effects of losartan on a background of hydrochlorothiazide in patients with hypertension. Hypertension. 1995;26:112–117
  83. Takahashi S, Moriwaki Y, Yamamoto T, et al. Effects of combination treatment using anti-hyperuricaemic agents with fenofibrate and/or losartan on uric acid metabolism. Annals of the Rheumatic Diseases. 2003;62:572–575
  84. Feher MD, Hepburn AL, Hogarth MB, et al. Fenofibrate enhances urate reduction in men treated with allopurinol for hyperuricaemia and gout. Rheumatology (Oxford). 2003;42:321–325
  85. Chanard J, Toupance O, Lavaud S, et al. Amlodipine reduces cyclosporine-induced hyperuricaemia in hypertensive renal transplant recipients. Nephrology, Dialysis, Transplantation: Official Publication of the European Dialysis and Transplant Association - European Renal Association. 2003;18:2147–2153
  86. Emmerson BT. Effect of oral fructose on urate production. Annals of the Rheumatic Diseases. 1974;33:276–280
  87. Fox IH, Kelley WN. Studies on the mechanism of fructose-induced hyperuricemia in man. Metabolism. 1972;21:713–721
  88. Schumacher HR. Febuxostat: a non-purine, selective inhibitor of xanthine oxidase for the management of hyperuricaemia in patients with gout. Expert Opinion on Investigational Drugs. 2005;14:893–903
  89. Bomalaski JS, Clark MA. Serum uric acid lowering therapies: where are we heading in management and the potential role of uricase. Current Rheumatology Reports. 2004;6:240–247
  90. Fourgueray P, Zeiller J-J. Potent and rapid uricosuric effect of single and repeated doses of EMD 336340 in healthy volunteers. Arthritis and Rheumatism. 2005;52(supplement):501;(abstract)
  91. Garg JP, Chasan-Taber S, Blair A, et al. Effects of sevelamer and calcium-based phosphate binders on uric acid concentrations in patients undergoing hemodialysis. A randomized clinical trial. Arthritis and Rheumatism. 2005;52:290–295
  92. German DC. A simple measurement to monitor the size of gouty tophi and rheumatoid nodules. Journal of Clinical Rheumatology. 1997;3:45–46
  93. Schumacher HR, Becker MA, Wortmann R, et al. Magnetic resonance imaging of gouty tophi during treatment with febuxostat, a non purine selective inhibitor of xanthine oxidase. Arthritis and Rheumatism. 2004;50:S336
  94. Kumar S, Gow P. A survey of indications, results and complications of surgery for tophaceous gout. The New Zealand Medical Journal. 2002;115:v109–v112
  95. Fam AG, Dunne SM, Iazzetta J, Paton TW. Efficacy and safety of desensitization to allopurinol following cutaneous reaction. Arthritis and Rheumatism. 2001;44:231–238
  96. Vazquez-Mellado J, Vazquez SG, Barrientos JC, et al. Desensitization to allopurinol after allopurinol hypersensitivity syndrome with renal involvement in gout. Journal of Clinical Rheumatology. 2000;6:266–268
  97. Hoffman L. My gout and allopurinol desensitization. Journal of Clinical Rheumatology. 2002;8:354–357
  98. Hung SI, Chung WH, Liou LB, et al. HLA-B*5801 allele as a genetic marker for servere cutaneous adverse reactions caused by allopurinol. Proceedings of the National Academy of Sciences of the United States of America. 2005;102:4134–4139
  99. Schlesinger N. Management of acute and chronic gouty arthritis. Drugs. 2004;64:2399–2416
  100. Mikuls TR, Saag KG. Gout treatment: what is evidence based and how do we determine and promote optimized clinical care?. Current Rheumatology Reports. 2005;7:242–249
  101. Bieber JD, Terkeltaub RA. On the brink of novel therapeutic options for an ancient disease. Arthritis and Rheumatism. 2004;50:2400–2414
  102. Scott JJ. New knowledge on the pathogenesis of gout. Journal of Clinical Pathology. 1978;12:205–213

PII: S1521-6942(06)00054-4

doi: 10.1016/j.berh.2006.05.006

Best Practice & Research Clinical Rheumatology
Volume 20, Issue 4 , Pages 673-684 , August 2006

Article Tools