Dual-drug nanocarriers for gout therapy: targeted co-delivery of anti-inflammatory and urate-lowering agents: a review

Gout, a prevalent form of inflammatory arthritis, arises from the deposition of monosodium urate crystals in joints due to chronic hyperuricemia. Current pharmacologic monotherapies such as xanthine oxidase inhibitors, uricosurics, NSAIDs, corticosteroids, and colchicine are often limited by inadequate dual-action efficacy, suboptimal bioavailability, and systemic side effects. Emerging nanocarrier-based drug delivery systems offer a promising alternative by improving pharmacokinetics and enhancing targeted delivery to inflamed tissues. While co-encapsulation of multiple therapeutics remains underexplored in gout, advances in related inflammatory diseases support its future application. This review explores the limitations of conventional gout therapies and highlights recent advancements in nanocarrier technologies, including liposomes, niosomes, and ethosomes, for delivering both anti-inflammatory and urate-lowering agents. Special attention is given to functionalization strategies that allow for site-specific delivery and sequential drug release, particularly in the acidic and oxidative microenvironments characteristic of acute gout flares. Co-delivery of agents such as allopurinol or febuxostat with NSAIDs or corticosteroids may reduce pill burden, improve therapeutic synergy, and enhance patient adherence. While clinical translation remains in early stages, the mechanistic rationale and encouraging preclinical outcomes of responsive, functionalized nanocarriers underscore their potential to advance precision medicine in gout management. See also the graphical abstract(Fig. 1).