Erosive gout: update on mechanisms, impact and treatment

PURPOSE OF REVIEW: Erosive gout refers to the presence of at least one gouty bone erosion in a person with gout. This review provides an update on the update on mechanisms, impact, and treatment of erosive gout. RECENT FINDINGS: Erosive gout is usually the consequence of long-standing tophaceous disease. However, bone erosions in association with tophi can be detected on ultrasound before onset of clinical symptoms in some people with asymptomatic hyperuricaemia. SPP1 (osteopontin)-expressing macrophages have been implicated in pathogenesis of tophaceous gout and SPP1-mediated cellular interactions may influence bone remodelling in the context of erosive gout. In addition to joint deformity, people with erosive gout experience more frequent gout flares and have low rates of disease remission, even with intensive urate-lowering therapy. Oral urate-lowering therapy using a treat to target serum urate approach can prevent progression of erosive gout, and small serial imaging studies have demonstrated infilling of monosodium urate crystal-related bone erosion in pegloticase responders. SUMMARY: Erosive gout is a consequence of tophaceous gout and causes joint deformity which is difficult to reverse once established. Collectively, these findings provide a rationale for urate-lowering therapy for people with gout to prevent the consequences of tophaceous gout including joint damage.