Management of Gout
Publication Date: May 20, 2020
Last Updated: April 13, 2022
Recommendations
Indications for pharmacologic urate-lowering therapy (ULT)
For patients with 1 or more subcutaneous tophi, we strongly recommend initiating ULT over no ULT. (High-quality evidence, Strong recommendation)
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For patients with radiographic damage (any modality) attributable to gout, we strongly recommend initiating ULT over no ULT. (Moderate-quality evidence, Strong recommendation)
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For patients with frequent gout flares (>2/year), we strongly recommend initiating ULT over no ULT. (High-quality evidence, Strong recommendation)
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For patients who have previously experienced >1 flare but have infrequent flares (<2/year), we conditionally recommend initiating ULT over no ULT. (Moderate-quality evidence, Conditional recommendation)
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For patients experiencing their first flare, we conditionally recommend against initiating ULT over no ULT, with the following exceptions. (Moderate-quality evidence, Conditional recommendation)
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For patients experiencing their first flare and CKD stage >3, SU >9 mg/dl, or urolithiasis, we conditionally recommend initiating ULT. (Very low-quality evidence, Conditional recommendation)
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For patients experiencing their first flare and CKD stage >3, SU >9 mg/dl, or urolithiasis, we conditionally recommend initiating ULT. (High-quality evidence, Conditional recommendation)
- There is randomized clinical trial data to support the benefit that ULT lowers the proportion of patients who develop incident gout. However, based on the attributable risk, 24 patients would need to be treated for 3 years to prevent a single (incident) gout flare leading to the recommendation against initiating ULT in this patient group.
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Overview
Title
Management of Gout
Authoring Organization
American College of Rheumatology