Penatalaksanaan Gout

Oleh :

dr.Eveline Yuniarti

Penatalaksanaan gout yang utama adalah menurunkan kadar asam urat. Terapi farmakologis untuk penurun asam urat meliputi golongan xanthine-oxidase inhibitor, uricase analog, atau uricosurics. Pemberian obat ini dapat didahului terapi fase akut berupa kolkisin, analgesik, atau steroid. Terapi non farmakologis mencakup modifikasi gaya hidup. Pembedahan dapat dipertimbangkan bila semua terapi lain tidak menghasilkan respon yang adekuat.[1-3]

Hiperurisemia Asimtomatik

Pasien dengan hiperurisemia asimtomatik tidak direkomendasikan untuk mendapat terapi farmakologi apapun. Bagi pasien dengan hiperurisemia asimtomatik dan hipertensi, urate-lowering therapy (ULT) juga tidak direkomendasikan untuk tujuan mengurangi risiko penyakit kardiovaskular mayor atau mortalitas.[2,3]

Referensi

1. Perhimpunan Reumatologi Indonesia. Pedoman Diagnosis dan Pengelolaan Gout. 2018.
2. FitzGerald JD, Dalbeth N, Mikuls T, Brignardello-Petersen R, Guyatt G, Abeles AM, et al. 2020 American College of Rheumatology Guideline for the Management of Gout. Arthritis Care Res (Hoboken) 2020;72:744–60. https://doi.org/10.1002/acr.24180.
3. Lorenzo JPP, Sollano MHMZ, Salido EO, Li-Yu J, Tankeh-Torres SA, Wulansari Manuaba IAR, et al. 2021 Asia-Pacific League of Associations for Rheumatology clinical practice guideline for treatment of gout. Int J Rheum Dis 2022;25:7–20. https://doi.org/10.1111/1756-185X.14266.
4. Skoczyńska M, Chowaniec M, Szymczak A, Langner-Hetmańczuk A, Maciążek-Chyra B, Wiland P. Pathophysiology of hyperuricemia and its clinical significance – a narrative review. Reumatologia 2020;58:312–23. https://doi.org/10.5114/reum.2020.100140.
5. Ragab G, Elshahaly M, Bardin T. Gout: An old disease in new perspective – A review. J Adv Res 2017;8:495–511. https://doi.org/10.1016/j.jare.2017.04.008.
7. Yazdany J, Manno RL. Rheumatologic, Immunologic, & Allergic Disorders. In: Papadakis MA, McPhee SJ, Rabow MW, McQuaid KR, editors. Current Medical Diagnosis and Treatment 2022. 61st ed., McGraw-Hill; 2022, p. 825–83.
20. Engel B, Just J, Bleckwenn M, Weckbecker K. Treatment Options for Gout. Dtsch Arztebl Int. 2017 Mar 31;114(13):215-222. doi: 10.3238/arztebl.2017.0215. PMID: 28434436; PMCID: PMC5624445. https://doi.org/10.1002/acr.24180.
21. Sun R, Lu J, Li H, Cheng X, Xin Y, Li C. Evaluation of febuxostat initiation during an acute gout attack: A prospective, randomized clinical trial. Joint Bone Spine 2020;87:461–6. https://doi.org/10.1016/j.jbspin.2020.03.017.
22. Mackenzie IS, Ford I, Nuki G, Hallas J, Hawkey CJ, Webster J, et al. Long-term cardiovascular safety of febuxostat compared with allopurinol in patients with gout (FAST): a multicentre, prospective, randomised, open-label, non-inferiority trial. The Lancet 2020;396:1745–57. https://doi.org/10.1016/S0140-6736(20)32234-0.
23. Schlesinger N, Lipsky PE. Pegloticase treatment of chronic refractory gout: Update on efficacy and safety. Semin Arthritis Rheum 2020;50:S31–8. https://doi.org/10.1016/j.semarthrit.2020.04.011.
24. Guttmann A, Krasnokutsky S, Pillinger MH, Berhanu A. Pegloticase in gout treatment - safety issues, latest evidence and clinical considerations. Ther Adv Drug Saf 2017;8:379–88. https://doi.org/10.1177/2042098617727714.
26. Zhao SS, Rajasundaram S, Karhunen V, Alam U, Gill D. Sodium-glucose cotransporter 1 inhibition and gout: Mendelian randomisation study. Semin Arthritis Rheum 2022;56:152058. https://doi.org/10.1016/j.semarthrit.2022.152058.
27. Bernardes ACFPF, Matosinhos RC, de Paula Michel Araújo MC, Barros CH, de Oliveira Aguiar Soares RD, Costa DC, et al. Sesquiterpene lactones from Lychnophora species: Antinociceptive, anti-inflammatory, and antioxidant pathways to treat acute gout. J Ethnopharmacol 2021;269. https://doi.org/10.1016/j.jep.2020.113738.

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