Gout is the most common inflammatory arthritis in western countries and the incidence is increasing. Additionally, evidence now exists that cases of severe, refractory gout seem to be increasing. The management of gout and hyperuricemia has remained largely unchanged for decades and includes antiinflammatories used initially for acute attacks and primarily allopurinol to prevent future attacks. Evidence-based guidance for the management of gout and hyperuricemia has been plagued by a lack of randomized, controlled studies and the lack of new medications. Recently evidence-based guidelines by the European League Against Rheumatism were published; one of the first attempts by a major medical body to assess the state of gout and hyperuricemia treatment. Additionally, several new compounds seem poised to be released for hyperuricemia treatment. This review details the important aspects of the gout guidelines relating to pharmacotherapy and critically examines the data surrounding new modalities to decrease serum uric acid.
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