Current Topics on Gout and Hyperuricemia

Therapeutic strategy for gout and hyperuricemia is now well established by the availability of potent anti-hyperuricemic drugs. By virtue of these agents, serious complications including gouty kidney caused by the deposition of urate have been apparently decreased. On the other hand, prevalence of hyperuricemic males is expanding and the onset age of gout has become younger. Recently, insulin resistance has been implicated to be involved in the pathogenesis of hyperuricemia, and thus, hyperuricemia is considered as one of multiple risk factors syndromes. Also, evidences have been accumulated to support that hyperuricemia is a risk factor for coronary heart diseases at least in patients with hypertension. Genetic abnormalities of the enzymes involved in the purine metabolism have been shown to be a pathogenesis of gout, and now molecular investigation on the mechanism of the renal excretion of uric acid is the critical issue in the pathogenesis of gout and hyperuricemia. In clinical point of view, there are many misunderstandings in the diagnosis or the treatment of patients with gout. Establishment of the definitive therapeutic guideline and the educational program are considered to be necessary for the better management of patients with gout or hyperuricemia