Strategies for the treatment of gout: control of hyperuricemia and prevention of complications

Gout is a metabolic disease characterized by chronic hyperuricemia and the deposition of sodium monourate crystals in tissues. With the increasing prevalence of the disease, there is a need to change therapeutic strategies. Objective. To analyze current data on strategies for treatment and prevention of gout and its complications. Materials and methods. The review was based on an analysis of papers published in international and Russian scientific databases (PubMed, Scopus, Web of Science, eLibrary) for 2019—2025. Original studies, meta-analyses, and reviews that meet the criteria of scientific reliability, clinical significance, and relevance were included. The publications were selected using keywords in Russian and English, in accordance with the guidelines of leading international and national professional communities. Results. Data from clinical studies confirming the efficacy of uricostatic agents with appropriate dose titration are presented. Benzbromarone was found to have high urate-lowering activity in patients with hypouricosuric hyperuricemia. Particular attention is paid to promising selective inhibitors of uric acid transporter proteins that provide clinical efficacy and an acceptable safety profile. The potential of enzyme-based agents, in particular pegloticase, whose effectiveness increases significantly when combined with methotrexate, was analyzed. Conclusion. Current strategies for the treatment of gout focus on achieving a sustained reduction in uric acid levels to target values, while accounting for the pathogenetic mechanisms of hyperuricemia. Individualized drug selection improves treatment efficacy. New selective drugs and combinations of biological agents with immunosuppressants offer prospects for treating resistant forms of gout.