Therapeutic Areas Doctors & Pharmacists

Rheumatology

Rheumatology is a branch of internal medicine that deals with inflammatory diseases of the musculoskeletal system and connective tissue throughout the body.

A. Menarini Pharma offers Adenuric^®, a preparation for the treatment of gout.

What is gout?

Gout is an inflammatory and progressive disease caused by deposits of monosodium urate crystals in tissues and joints.

Gout is the most common form of inflammatory arthritis in the adult population, and its increasing prevalence can be attributed to changes in diet and lifestyle, the use of hyperuricemia-causing drugs, the increasing incidence of metabolic syndrome, and longevity. Men are more commonly affected than women, with the proportion of women increasing after menopause.

A prerequisite for the development of this disease is hyperuricemia (elevated serum uric acid), which results in the formation of monosodium urate crystals. These in turn are responsible for inflammatory episodes and the formation of deposits (tophi), including in extra-articular tissues. Persistence of hyperuricemia can lead to damage to the joints and kidneys (nephrolithiasis). However, it is also an independent risk factor for cardiovascular events.

How is gout characterized?

Four clinical stages can be distinguished in the course of gout:

• Asymptomatic hyperuricemia

• Acute gouty arthritis, manifested by the sudden onset of severe pain, redness, warmth and swelling at the affected joint and surrounding tissues

• Intercritical gout, includes periods when patients have no further arthritic episodes

• Chronic gout, characterized by polyarthritis, sometimes with irreversible damage to the affected joints, tophi, and visceral involvement

Therapy of gout

As stated in the recommendations of the European League Against Rheumatism (EULAR)¹, the goal of therapy in chronic gout is to promote the dissolution of urate crystals and prevent their formation. This can be achieved by maintaining serum uric acid levels below the monosodium urate saturation point of 6.8 mg/dl. By lowering serum uric acid below 6 mg/dl (or 5 mg/dl for severe gout) over the long term, tophi can be cleared and the occurrence of acute gout attacks can be reduced or even prevented.

Permanent adjustment of serum uric acid below the target level of 6 (5) mg/dl is effectively possible through the use of serum uric acid (urate) lowering drugs.

What are the urate-lowering drugs?

There are two categories of urate-lowering medications: Uricosurics (promoting the excretion of uric acid) and Uricostats (inhibiting the formation of uric acid).

Reference: 1 Richette P et al., Ann Rheum Dis 2017; 76:29–42

AT-WEB-41-10-2021