The many faces of gout: modern treatment concepts

Gout is a systemic disease caused by the deposition of monosodium urate crystals in various tissues and organs with the subsequent development of autoinflammation. The problem of comorbidity in gout has been known for a long time and continues to be actively studied. The gout is associated with cardiovascular diseases, metabolic and metabolic disorders, kidney diseases, and hyperuricemia plays an important role in these associations. Therefore, the elimination of hyperuricemia is the basis of the modern strategy of effective therapy for gout, the main principle of which is “treat-to-target” (serum uric acide concentration <360 μmol/L [6 mg/dL]). Nevertheless, many patients who need treatment for gout still do not receive therapy or receive suboptimal therapy, which significantly increases the risks of overall and cardiovascular mortality. In this regard, it is of great importance that physicians are aware of the indications, optimal timing of initiation and purposes of urate-lowering therapy, as well as strengths and weaknesses of certain urate-lowering drugs, including skin, kidneys, heart, and liver adverse events. The review highlights the modern principles of urate-lowering therapy, including the place of febuxostat in the treatment of patients with gout.