Management of Gout
Key Points
Key Points
- Gout is the most common form of inflammatory arthritis, affecting ~9.2 million adults (3.9%) in the US.
- These guidelines reinforce the strategy of starting with low-dose urate-lowering therapy (ULT) and titrating up to achieve the SU target. This strategy mitigates the risk of treatment-related adverse effects (e.g.,hypersensitivity) as well as flare risk accompanying ULT initiation.
Treatment
Tre...
...Table 1. Indications f...
...atients with 1 or more subcutaneous...
...h radiographic damage (any modality) attributable...
...ith frequent gout flares (≥2/year), we str...
...who have previously experienced >1...
...eriencing their first flare, we con...
...nts experiencing their first flare and CKD...
...with asymptomatic hyperuricemia (SU >6.8 mg/dl wi...
...T...
...atients starting any ULT, we strong...
...rongly recommend a xanthine oxidase inhibitor...
...and febuxostat, we strongly recommend st...
...benecid, we conditionally recommend st...
...mmend initiating concomitant antiinflammator...
...rongly recommend continuing prophylaxis for...
...sion is made that ULT is indicated while the patie...
...rongly recommend against pegloticase as first...
...Table 3. Recommenda...
...l patients taking ULT, we strongly recomm...
...ients taking ULT, we strongly reco...
...s taking ULT, we conditionally recommend deli...
...y recommend continuing ULT indefinitely...
...Table...
...Allopurinol...
...y recommend testing HLA–B*5801 prior to...
...ionally recommend against HLA–B*5801 te...
For patients with a prior allergic response...
...Febuxosta...
...patients with gout taking febuxostat w...
...Uricosurics...
For patients considered for, or ta...
...ing uricosuric treatment, we condit...
...T...
...ts with gout taking their first XOI monotherapy at...
...patients with gout where XOI, uricosurics,...
...ith gout for whom XOI, uricosurics, and other int...
...or patients experiencing a gout flare, we...
...hicine is the chosen agent, we strongly...
...xperiencing a gout flare for whom ot...
...tients who may receive NPO, we strongly r...
...atients experiencing a gout flare, we conditional...
...Table 7. Manageme...
...ith gout, regardless of disease activity,...
...patients with gout, regardless of disease activity...
...nts with gout, regardless of disease activi...
...t/obese patients with gout, regard...
...ith gout, regardless of disease activity, w...
...Table 8. Mana...
...ith gout, regardless of disease activity,...
...ionally recommend choosing losartan pr...
...itionally recommend against stopping low-dose asp...
...y recommend against adding or switching to fe...