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
...eatment...
...Indications for pharmacologic ULT...
...nts with 1 or more subcutaneous tophi, we stro...
...ts with radiographic damage (any modalit...
...h frequent gout flares (≥2/year)...
...patients who have previously experie...
...r patients experiencing their first flare, we con...
...tients experiencing their first flare and CKD s...
...nts with asymptomatic hyperuricemi...
...ecommendations for choice of initial ULT i...
...r patients starting any ULT, we strongly recomm...
...ecommend a xanthine oxidase inhibitor over prob...
...inol and febuxostat, we strongly recommend sta...
...d, we conditionally recommend starting a...
...ongly recommend initiating concomitant a...
...ecommend continuing prophylaxis fo...
...e decision is made that ULT is indica...
...gly recommend against pegloticase as first-line th...
...Recommendations for all patients taking UL...
...ts taking ULT, we strongly recommend a trea...
...s taking ULT, we strongly recommend continuing...
...all patients taking ULT, we conditionally recomme...
...ionally recommend continuing ULT indefinitel...
...mendations for patients taking specific ULT medi...
...opurinol...
...onditionally recommend testing HLA–B*5801...
...conditionally recommend against HLA–B*5801 t...
...with a prior allergic response to a...
Febuxos...
...s with gout taking febuxostat with a history...
Uricosuric...
...patients considered for, or taking uricosuric t...
...taking uricosuric treatment, we conditional...
...e 5. When to consider switching to a new ULT s...
...or patients with gout taking their first XOI...
...h gout where XOI, uricosurics, and other inte...
...patients with gout for whom XOI, uricos...
...ble 6. Gout flare manageme...
...ients experiencing a gout flare, we strongly...
...colchicine is the chosen agent, we stron...
...or patients experiencing a gout fla...
...atients who may receive NPO, we st...
...ents experiencing a gout flare, we condit...
...anagement of lifestyle factors...
...with gout, regardless of disease activity,...
...patients with gout, regardless of disease ac...
...patients with gout, regardless of disease...
...overweight/obese patients with gout,...
...s with gout, regardless of disease activity,...
...8. Management of concurrent me...
...th gout, regardless of disease activity, we condit...
...recommend choosing losartan preferentially a...
...tionally recommend against stopping...
...onditionally recommend against adding or swit...