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
Treatment
...1. Indications for pharmaco...
...ients with 1 or more subcutaneous tophi, w...
...h radiographic damage (any modality) attributabl...
...ith frequent gout flares (≥2/year), we strongly...
...patients who have previously experienced >1 flar...
...experiencing their first flare, we conditi...
...nts experiencing their first flare and CKD stag...
...ents with asymptomatic hyperuricemia (SU...
...Recommendations for choice of ini...
...tients starting any ULT, we strongly recom...
...ly recommend a xanthine oxidase inhibitor ov...
...and febuxostat, we strongly recommend star...
...we conditionally recommend starting at a low...
...rongly recommend initiating concomi...
...ongly recommend continuing prophylaxis fo...
...ision is made that ULT is indicated w...
We strongly recommend against peglotica...
...endations for all patients taking ULT...
...s taking ULT, we strongly recommend a treat-t...
...patients taking ULT, we strongly re...
...tients taking ULT, we conditionally recommend...
...conditionally recommend continuing ULT in...
...le 4. Recommendations for patients taking specific...
...llopurino...
...onally recommend testing HLA–B*5801 prior t...
...ly recommend against HLA–B*5801 te...
...ts with a prior allergic response to allopurinol w...
Febuxosta...
...ents with gout taking febuxostat with a history o...
Uricosurics
...nts considered for, or taking uricos...
...r patients taking uricosuric treatment, we c...
...consider switching to a new ULT strategy...
...ts with gout taking their first XOI m...
...ts with gout where XOI, uricosurics, and other in...
...with gout for whom XOI, uricosurics, and other...
...out flare management...
...experiencing a gout flare, we strongly recom...
...lchicine is the chosen agent, we strongly recommen...
...experiencing a gout flare for whom othe...
...nts who may receive NPO, we strongly r...
...s experiencing a gout flare, we conditiona...
...ble 7. Management of lifestyle fa...
...with gout, regardless of disease activity,...
...r patients with gout, regardless of disease acti...
...nts with gout, regardless of disease activity,...
...weight/obese patients with gout, re...
...ients with gout, regardless of disease activity,...
...Management of concurrent medications...
...patients with gout, regardless of disease ac...
...nally recommend choosing losartan p...
...e conditionally recommend against stopping l...
...ly recommend against adding or switching...