We concluded that tophi around the bipartite patella should be treated by a combination of surgical excision and uricosuric agents
to prevent deposition causing recurrence of gouty attacks and to preserve the second part of patella as much as possible.
(40) Since uricosuric agents such as benzbromarone are relatively ineffective in patients with renal insufficiency, this observation suggests that urate lowering agents are only likely to prove beneficial when they actually lower urate.
Efficacy and safety of a range of doses of FDEA594, a novel uricosuric agent, as a single agen in hyperuricemic gout patients: multicenter, randomized, double-blind, placebo-controlled phase 2 experience.
As with uricosuric agents
, drug-drug interactions also are a problem with allopurinol.
Drug-drug interactions are a problem with uricosuric agents
and with allopurinol.
Fortunately, novel, effective antihyperuricemics are in clinical development to counter the limitations of allopurinol and uricosuric agents. In addition, the linkage of gouty inflammation to critical engagement of specific mediators of innate immunity and to effects of IL-1[beta] augurs well for novel treatment strategies for gouty inflammation in refractory patients.
(7) Risk for nephrolithiasis with any uricosuric agent is a concern.
Some guidelines use uric acid excretion rates to help with that choice: A xanthine oxidase inhibitor, such as allopurinol, is recommended for those excreting more than 800 mg/24 hr, and uricosuric agents
are recommended for those with lower rates.
A low-purine diet has a minor role today for treating hyperuricemia because allopurinol and the uricosuric agents
are so effective at lowering uric acid levels.