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
...Table 1. Indication...
...ts with 1 or more subcutaneous tophi, we st...
For patients with radiographic damage (any mod...
...th frequent gout flares (≥2/year), we strongly...
...ents who have previously experienced...
...experiencing their first flare, we conditi...
...ts experiencing their first flare and CKD stag...
...ients with asymptomatic hyperuricemi...
...Table 2. Recommendations fo...
...starting any ULT, we strongly recommend allopuri...
...ommend a xanthine oxidase inhibitor ov...
...allopurinol and febuxostat, we strongly reco...
...we conditionally recommend starting at...
...trongly recommend initiating concomitant ant...
...strongly recommend continuing prophylaxi...
...cision is made that ULT is indicate...
...ecommend against pegloticase as first-...
...Table...
...or all patients taking ULT, we str...
...s taking ULT, we strongly recommend contin...
...all patients taking ULT, we condi...
...tionally recommend continuing ULT indefin...
...Table 4. Recommenda...
...y recommend testing HLA–B*5801 prior to...
...recommend against HLA–B*5801 testing in all ot...
...ents with a prior allergic response to allopurino...
...Febuxostat...
...ith gout taking febuxostat with a history of CVD...
...Uricosurics...
...considered for, or taking uricosuric...
...nts taking uricosuric treatment, we conditi...
...Table 5. W...
...patients with gout taking their first X...
...atients with gout where XOI, urico...
...ents with gout for whom XOI, urico...
...Table 6. Go...
...r patients experiencing a gout flare, we strongly...
...hicine is the chosen agent, we strongly rec...
...experiencing a gout flare for whom...
...atients who may receive NPO, we strongly recom...
...xperiencing a gout flare, we conditi...
...Table 7...
...with gout, regardless of disease activity, we co...
...ents with gout, regardless of disease activity,...
...nts with gout, regardless of disease ac...
...ght/obese patients with gout, regard...
...tients with gout, regardless of disease activ...
...Tab...
...with gout, regardless of disease a...
...ditionally recommend choosing losartan pre...
...onditionally recommend against stopp...
...y recommend against adding or switchin...