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...
...e 1. Indications for pharmacologic...
...tients with 1 or more subcutaneous t...
...with radiographic damage (any modality)...
...or patients with frequent gout flares...
...o have previously experienced >1 flare but have in...
...ients experiencing their first flare, we condition...
...r patients experiencing their first flare and...
...nts with asymptomatic hyperuricemia (SU >6.8 mg/d...
.... Recommendations for choice of initial U...
...nts starting any ULT, we strongly recommend a...
...ecommend a xanthine oxidase inhibitor over proben...
...lopurinol and febuxostat, we strongly recommend...
...r probenecid, we conditionally recommend...
...ly recommend initiating concomitant antiinflammato...
...commend continuing prophylaxis for...
...hen the decision is made that ULT is indicated wh...
...ecommend against pegloticase as fi...
.... Recommendations for all patients tak...
...ts taking ULT, we strongly recomme...
...ients taking ULT, we strongly recommend continuin...
...ll patients taking ULT, we conditi...
...itionally recommend continuing ULT i...
.... Recommendations for patients takin...
...llopurinol
...onally recommend testing HLA–B*580...
...recommend against HLA–B*5801 tes...
...nts with a prior allergic response to allopuri...
Febuxos...
...th gout taking febuxostat with a history of CVD o...
...icosurics...
For patients considered for, or taking...
...or patients taking uricosuric treatment, we c...
...ble 5. When to consider switching to a new ULT...
...patients with gout taking their first XOI mo...
...with gout where XOI, uricosurics, and o...
...with gout for whom XOI, uricosurics...
Table 6. Gout flare managem...
...experiencing a gout flare, we strongly...
...cine is the chosen agent, we strongly rec...
...ients experiencing a gout flare for wh...
...may receive NPO, we strongly recommend glucoco...
...atients experiencing a gout flare, we c...
...Management of lifestyle facto...
...with gout, regardless of disease acti...
...ients with gout, regardless of disease activity,...
...ith gout, regardless of disease acti...
For overweight/obese patients with gout, regar...
...s with gout, regardless of disease acti...
...ment of concurrent medications...
...h gout, regardless of disease activity...
...conditionally recommend choosing l...
...tionally recommend against stopping l...
...lly recommend against adding or switching...