Gout is a common medical condition characterized by the accumulation of monosodium urate (MSU) monohydrate crystals in the tissues, often resulting in painful flares that can last for one to two weeks. According to the National Institutes of Health (NIH), gout is more prevalent in men than in women and typically presents in middle age. However, with timely diagnosis, appropriate treatment, and lifestyle adjustments, gout can be effectively managed and controlled, making it one of the more manageable forms of arthritis.

In this article, we will delve into the most recent guidelines on gout, as outlined by the American College of Rheumatology (ACR) and the American College of Physicians (ACP). Since the publication of these guidelines, two new medications have been approved for the treatment of gout. This article will explore the changes that have occurred since the guidelines were last updated in 2020 and speculate on how future Clinical Practice Guidelines for gout may be influenced by these recent FDA approvals.

Part 1 – Current Gout Guidelines

To start, here is a listing of some of the most recent gout treatment and management guidelines published in the US:

Part 2 – FDA Approvals Since the Most Recent Guidelines

The medications/therapies that have been approved by the FDA since the last ACR Gout Clinical Guideline Published in May 2020:

  • ILARIS® (canakinumab) injection
    • Novartis Pharmaceuticals
    • FDA Approved for Gout in August 2023
    • ILARIS is an interleukin-1β blocker indicated for the treatment of gout flares in adults who cannot be treated with NSAIDs, colchicine, or repeated courses of corticosteroids.

  • Krystexxa® (pegloticase) injection co-administered with methotrexate
    • Horizon Therapeutics (Acquired by Amegen)
    • FDA Approved for Gout in July 2022
    • KRYSTEXXA® (pegloticase) is a PEGylated uric acid specific enzyme indicated for the treatment of chronic gout in adult patients refractory to conventional therapy.

Part 3 – Predictions

Now that we’ve covered the current available gout guidelines, the “what’s changed” and new FDA approvals since the most recent 2020 publication, we can jump into the predictions. As a reminder, this is a list of predictions focused specifically on treatment of gout, and including pharmacological treatments. These predictions are not based on specific guidelines or a specific organization, but instead provide broad, high-level predictions covering potential next guideline(s) on the topic of gout, regardless of which organization produces them.

  • Prediction 1
    • New Medications: Inclusion of the most recent FDA approved medications as well as new urate-lowering therapies or other medications that have shown efficacy in clinical trials.
  • Prediction 2
    • Digital Health Tools: The integration of telemedicine and mobile health apps is enhancing patient monitoring and management, making it easier for patients to track their symptoms and medication adherence.  eGFR Tracker, Albumin-to-Creatinine Ratio Tracker, Uric Acid Tracker, and Gout Flare Tracker. Also, potentially providing guidance and tracking on diet, exercise, and other lifestyle factors that can aid in the management of gout.
  • Prediction 3
    • Dual-Energy Computed Tomography (DECT): Potentially adding advanced imaging technology that enables accurate detection and measurement of uric acid crystal deposits in joints and tissues. This innovative tool enhances the diagnostic process and facilitates monitoring of conditions related to these deposits.

There you have it – an overview of the current gout guidelines, updates on recent major changes and FDA approvals have happened since publication, and our informal, but evidence-based, predictions for what the next guidelines on gout may include. Once the next gout guideline update happens, we will compare our predictions to reality to see how we measured up. Do you agree with our predictions? Do you think we missed anything? We’d love to hear your input!

Do you agree with our predictions? Do you think we missed anything? And is there another topic you would like to see covered in a future guideline predictions series article? Contact us today and let us know!

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