Gout is a common metabolic disorder caused by high body uric acid levels, and marked by episodic deposition of uric acid crystals in joints (acute gouty arthritis) and other tissues such as the kidney (urate nephropathy or nephrolithiasis). The underlying condition appears to be an increase in total body uric acid stores and is usually marked by hyperuricemia. Hyperuricemia is typically defined as serum uric acid levels greater than 7.0 mg/dL. Gout is more common in men than women and usually has its onset in 4th or 5th decade of life. Approximately 1% of adult Americans report having gout and 5% have some degree of hyperuricemia.
Management of gout can be directed at treatment of acute attacks of gouty arthritis or to long term maintenance therapy directed at preventing attacks or decreasing the risk of uric acid nephropathy or nephrolithiasis. Treatment of acute attacks usually rests on use of nonsteroid antiinflammatory agents such as indomethacin, naproxen, sulindac or celecoxib. Colchicine (1961: Colbenemid and others) is used both during acute episodes and in chronic maintenance therapy. However, the major approach to long term prevention of gout and the complications of uric acid nephropathy is the use of uricosuric acids such as probenecid (1951: Benuryl) and benzbromarone (not available in the United States) and/or inhibitors of xanthine oxidase, such as the xanthine derivative allopurinol (1966: Aloprim) and the newer nonnucleoside xanthine oxidase inhibitors such as febuxostat (2009: Uloric, Adenuric).
Newer approaches to gout include use of lesinurad (Zurampic: 2015), a drug that inhibits the reabsorption of uric acid in the distal tubules of the kidney, and use of recombinant enzymes that metabolize uric acid such as pegloticase (Kystexxa), which is used in combination with xanthine oxidase inhibitors ito treat severe gout, and rasburicase (Elitek: 2002) which is used to treat the hyperuricemia associated with tumor lysis syndrome induced by cancer chemotherapy.