Debbie Rigby rounds up the latest in research news
Colchicine is currently approved for the treatment of gout. Studies indicate that it may be beneficial in a variety of other conditions, including other rheumatic diseases. Colchicine’s anti-inflammatory effects hold promise for prevention/management of cardiovascular conditions, including acute coronary syndromes.
The treat-to-target (T2T) approach is recommended for hyperuricaemia in gout. Different targets have been proposed; lower than 0.36 mmol/l for all patients, and at least 0.30 mmol/l for patients with severe—polyarticular or tophaceous—gout. Evidence suggests that not treating gout to target in the long term is overall associated with worsening outcomes, such as flares, tophi and structural damage, which is associated to loss of quality of life and mortality.
Misconceptions about gout are prevalent among both patients and doctors. non-pharmacological approaches should be used as adjuncts to urate-lowering treatment in gout. These include rest and topical ice application for acute attacks, avoidance of risk factors that can trigger acute attacks, and dietary interventions that may reduce gout attack frequency (e.g. cherry or cherry juice extract, skimmed milk powder or omega-3 fatty acid intake) or lower serum uric acid (e.g. vitamin C).
Allopurinol hypersensitivity syndrome (AHS) is a severe and sometimes life-threatening adverse drug reaction. Most cases occur within 8–9 weeks of commencing allopurinol. A low starting allopurinol dose may reduce AHS risk. Chronic kidney disease increases AHS risk, but slowly increasing the allopurinol dose in chronic kidney disease has not been associated with AHS.