Management of Gout

Publication Date: May 20, 2020

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

...ications for pharmacologic U...

For patients with 1 or more subcutaneous tophi, w...

For patients with radiographic damage (any...

...ts with frequent gout flares (≥2/...

...ts who have previously experienced...

...ents experiencing their first flare, we condit...

...nts experiencing their first flare and CKD st...

...ith asymptomatic hyperuricemia (SU >6.8 mg/dl...


...Recommendations for choice of initial...

...tarting any ULT, we strongly recommend allopu...

...ecommend a xanthine oxidase inhibitor o...

...allopurinol and febuxostat, we strongly r...

...obenecid, we conditionally recommen...

...recommend initiating concomitant antiinflamma...

...rongly recommend continuing prophyla...

...he decision is made that ULT is ind...

...ommend against pegloticase as first-line therap...


...3. Recommendations for all patients taking UL...

...all patients taking ULT, we strong...

For all patients taking ULT, we strongly recomme...

...all patients taking ULT, we condi...

...conditionally recommend continuing ULT indefini...


...ndations for patients taking specific ULT medica...

...opurinol...

...conditionally recommend testing HLA–B*5801 pri...

...onditionally recommend against HLA–B*5801 tes...

...with a prior allergic response to allop...

...buxostat...

...patients with gout taking febuxosta...

...icosurics...

...nts considered for, or taking urico...

...ients taking uricosuric treatment, we co...


...5. When to consider switching to a...

...tients with gout taking their first XOI mo...

...ts with gout where XOI, uricosurics,...

...patients with gout for whom XOI, uricosu...


...6. Gout flare managemen...

...or patients experiencing a gout flare, we strong...

...cine is the chosen agent, we strongly reco...

...atients experiencing a gout flare for whom ot...

...s who may receive NPO, we strongly recommend...

...or patients experiencing a gout fl...


...7. Management of lifestyle factors...

...ents with gout, regardless of disease activity,...

...with gout, regardless of disease...

...ents with gout, regardless of disease acti...

...obese patients with gout, regardless o...

...th gout, regardless of disease activity, we...


...nagement of concurrent medications...

...h gout, regardless of disease activ...

...nally recommend choosing losartan pr...

...conditionally recommend against stopping l...

...ly recommend against adding or switching to fe...