![]() ![]() Until recently the cost of medication for the treatment of chronic gout was relatively low, with the monthly cost for a single medication ranging from $18 to $100, depending on disease severity and duration. Pegloticase is administered biweekly by infusion in a healthcare setting. A newer therapeutic option, pegloticase, is a recombinant uricase reserved as a third-line agent in cases of refractory disease where a patient has failed or was not able to tolerate an appropriately dosed oral urate-lowering therapy. 7 The ACR further designated the combination of an XOI and a uricosuric as a second-line treatment in refractory disease. 8 Probenecid, a uricosuric, is recommended as an alternative first-line agent when either allopurinol or febuxostat is contraindicated or when a patient has demonstrated intolerance to at least 1 of the first-line agents. The American College of Rheumatology (ACR) has recommended first-line pharmacologic prophylaxis with a xanthine oxidase inhibitor (XOI), such as allopurinol or febuxostat, along with low-dose colchicine or an NSAID in treatment of chronic gout. For patients with chronic gout, the goal of treatment is to reduce the frequency of painful episodes by reducing and maintaining uric acid concentrations of less than 6 mg/dL using a combination of nonpharmacological interventions (ie, dietary and lifestyle changes) and pharmacological agents. 7 This is often achieved by the use of over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs), prescription corticosteroids, or colchicine. 7,8 The goal of treatment for an acute episode of gout is pain relief through reduction of inflammation. ![]() ![]() 6 The treatment goals for acute and chronic gout differ, as do the medications used in each setting ( 6 Medical conditions including obesity, diabetes, and renal insufficiency contribute to the risk of gout, as do medications such as diuretics and chemotherapeutic agents. 5 Risk factors for gout include lifestyle-related behaviors such as alcohol use and consumption of purine-rich foods, in particular organ meats and oily fishes. 3,4 Gout initially presents as an acute episode of arthritis, most commonly beginning in the metatarsalphalangeal joint at the base of the big toe. 1,2 Hyperuricemia, or elevated uric acid levels greater than 6.8 mg/dL, which result in the formation of monosodium urate crystals in joint tissues, is the primary cause of gout. Gout is a rheumatic disease affecting nearly 3.9% (8.3 million) of adults in the United States, with men almost 40% more likely to beafflicted than women. ![]()
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