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
...reatment
...ble 1. Indications for pharmacologic ULT...
For patients with 1 or more subcutaneou...
...tients with radiographic damage (any...
...h frequent gout flares (≥2/year),...
...atients who have previously experienced >1 fl...
...s experiencing their first flare, we conditionall...
...periencing their first flare and CKD stage ≥...
...patients with asymptomatic hyperuricem...
...mmendations for choice of initial U...
...arting any ULT, we strongly recommend allopur...
...recommend a xanthine oxidase inhibitor over p...
...or allopurinol and febuxostat, we strongly recomm...
...we conditionally recommend starting at...
...recommend initiating concomitant antiinflammat...
...ommend continuing prophylaxis for 3–6 m...
...n the decision is made that ULT is indicated...
...ecommend against pegloticase as first-li...
...Recommendations for all patients taking ULT...
...l patients taking ULT, we strongly recommend a t...
...patients taking ULT, we strongly recommen...
...ients taking ULT, we conditionally rec...
...itionally recommend continuing ULT indefinitely ov...
...commendations for patients taking sp...
...llopurinol...
...ally recommend testing HLA–B*5801 prior to...
...nally recommend against HLA–B*5801 testing in...
...or patients with a prior allergic response to...
...ebuxostat...
...patients with gout taking febuxostat wi...
...icosurics
...atients considered for, or taking uricosuric treat...
...taking uricosuric treatment, we conditionally re...
...to consider switching to a new ULT strateg...
...ients with gout taking their first XOI mo...
...ts with gout where XOI, uricosurics, an...
...r patients with gout for whom XOI, u...
...e 6. Gout flare managem...
...r patients experiencing a gout flare, we strong...
...ne is the chosen agent, we strongly...
...or patients experiencing a gout flare for whom o...
...who may receive NPO, we strongly recommend glucoc...
...s experiencing a gout flare, we co...
...7. Management of lifestyle fac...
...patients with gout, regardless of d...
...ts with gout, regardless of disease activity,...
For patients with gout, regardless of disease a...
...or overweight/obese patients with gout,...
...patients with gout, regardless of d...
...ment of concurrent medications...
...patients with gout, regardless of disease act...
...onally recommend choosing losartan preferentiall...
...y recommend against stopping low-dose aspirin...
...tionally recommend against adding or switc...