2020 American College of Rheumatology Guideline for the Management of Gout Academic Article uri icon

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abstract

  • OBJECTIVE: To provide guidance for the management of gout, including indications for and optimal use of urate-lowering therapy (ULT), treatment of gout flares, and lifestyle and other medication recommendations. METHODS: Fifty-seven population, intervention, comparator, and outcomes questions were developed, followed by a systematic literature review, including network meta-analyses with ratings of the available evidence according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology, and patient input. A group consensus process was used to compose the final recommendations and grade their strength as strong or conditional. RESULTS: Forty-two recommendations (including 16 strong recommendations) were generated. Strong recommendations included initiation of ULT for all patients with tophaceous gout, radiographic damage due to gout, or frequent gout flares; allopurinol as the preferred first-line ULT, including for those with moderate-to-severe chronic kidney disease (CKD; stage >3); using a low starting dose of allopurinol (≤100 mg/day, and lower in CKD) or febuxostat (<40 mg/day); and a treat-to-target management strategy with ULT dose titration guided by serial serum urate (SU) measurements, with an SU target of <6 mg/dl. When initiating ULT, concomitant antiinflammatory prophylaxis therapy for a duration of at least 3-6 months was strongly recommended. For management of gout flares, colchicine, nonsteroidal antiinflammatory drugs, or glucocorticoids (oral, intraarticular, or intramuscular) were strongly recommended. CONCLUSION: Using GRADE methodology and informed by a consensus process based on evidence from the current literature and patient preferences, this guideline provides direction for clinicians and patients making decisions on the management of gout.

authors

  • Brignardello, Romina
  • FitzGerald, John D
  • Dalbeth, Nicola
  • Mikuls, Ted
  • Brignardello‐Petersen, Romina
  • Guyatt, Gordon
  • Abeles, Aryeh M
  • Gelber, Allan C
  • Harrold, Leslie R
  • Khanna, Dinesh
  • King, Charles
  • Levy, Gerald
  • Libbey, Caryn
  • Mount, David
  • Pillinger, Michael H
  • Rosenthal, Ann
  • Singh, Jasvinder A
  • Sims, James Edward
  • Smith, Benjamin J
  • Wenger, Neil S
  • Bae, Sangmee Sharon
  • Danve, Abhijeet
  • Khanna, Puja P
  • Kim, Seoyoung C
  • Lenert, Aleksander
  • Poon, Samuel
  • Qasim, Anila
  • Sehra, Shiv T
  • Sharma, Tarun Sudhir Kumar
  • Toprover, Michael
  • Turgunbaev, Marat
  • Zeng, Linan
  • Zhang, Mary Ann
  • Turner, Amy S
  • Neogi, Tuhina

publication date

  • June 2020