JLE

Journal de Pharmacie Clinique

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Urate lowering therapies: an overview Volume 32, issue 1, Mars 2013

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Authors
Service Icar, Service de néphrologie, Groupe hospitalier Pitié-Salpêtrière, Paris, France

EULAR ( European league against rheumatism) guidelines recommend that plasma urate concentrations should be less than 60 mg/L or 360 μmol/L whether British guidelines recommend plasma urate concentrations as low as 50 mg/L or 300 μmol/L. In patients with chronic gout, a treatment has to be initiated in order to promote crystal dissolution and prevent crystal formation. Three kinds of treatments are available: 1) uricosuric agents such as probenecid and benzbromarone can enhance the renal excretion of urate; 2) uricolytic agents, such as pegloticase, which has just been approved by the FDA for refractory gout, can metabolize uric acid; 3) uricostatic agents, such as allopurinol and febuxostat can inhibit xanthine oxidase. Oral colchicine and/or NSAID are first line agents for systemic treatment of acute gout; in the absence of contraindications, an NSAID is a convenient and well accepted option. Corticosteroids can also be proposed as an alternative treatment.