Gout Pharmacotherapy in Cardiovascular Diseases

A Review of Utility and Outcomes

Subuhi Kaul; Manasvi Gupta; Dhrubajyoti Bandyopadhyay; Adrija Hajra; Prakash Deedwania; Edward Roddy; Mamas Mamas; Allan Klein; Carl J. Lavie; Gregg C. Fonarow; Raktim K. Ghosh


Am J Cardiovasc Drugs. 2021;21(5):499-512. 

In This Article

Management and Pharmacotherapies in Gout

The treatment of a gout flare involves monotherapy with non-steroidal anti-inflammatory drugs (NSAIDS) or cyclooxygenase-2 inhibitors, colchicine, or corticosteroids individualized for each patient (American College of Rheumatology [ACR] level A recommendation). These drugs target synovial neutrophil infiltration and suppress the acute inflammatory response. Colchicine is recommended for use within 36 h of a flare and a loading dose of 1.2 mg followed by 0.6 mg 1 h later effectively reduces pain by about 50%. For severe gout flares, colchicine can be used in combination with NSAIDs, oral corticosteroids, or intralesional corticosteroid injections. Thereafter, it can be continued prophylactically at a dose of 0.6 mg one to two times daily. Pharmacological properties of colchicine are detailed in Table 1.[6] Patients presenting with frequent flares, history of urolithiasis, glomerular filtration rate < 60 mL/min/1.73 m2 or higher, or presence of tophi should be started on ULT; however, all patients with gout should be made aware of the benefits of, and offered, ULT at diagnosis. The current ACR level A-recommended ULTs include the XO inhibitors, allopurinol, and febuxostat. Probenecid, a uricosuric, is a level B-recommended ULT in patients with intolerance to allopurinol or febuxostat. In refractory gout, a recombinant uricase (pegloticase) is the level A ACR-recommended drug.[7] Pharmacotherapies in gout are summarized in Table 1 and Table 2, with mechanism outlined in Figure 3.[9,10]

Figure 3.

Mechanism of urate-lowering drugs. AMP adenosine monophosphate, GMP guanosine monophosphate, IMP inosine monophosphate