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
Treatmen...
...ications for pharmacologic ULT
...or patients with 1 or more subcutan...
...s with radiographic damage (any modalit...
...with frequent gout flares (≥2/year)...
...tients who have previously experienced >...
...experiencing their first flare, we condi...
...experiencing their first flare and...
...patients with asymptomatic hyperuricemia...
...le 2. Recommendations for choice of initial UL...
...starting any ULT, we strongly recommend allopurino...
...ommend a xanthine oxidase inhibitor ove...
...and febuxostat, we strongly recommend sta...
...we conditionally recommend starting at a lo...
...trongly recommend initiating concomitant an...
...ommend continuing prophylaxis for 3–6 mont...
...decision is made that ULT is indicated...
...gly recommend against pegloticase as first-line...
...ble 3. Recommendations for all patients...
...patients taking ULT, we strongly recommen...
...ents taking ULT, we strongly recommen...
...ents taking ULT, we conditionally recommend...
...onally recommend continuing ULT indefinitely...
...ble 4. Recommendations for patients ta...
...llopurinol
...ly recommend testing HLA–B*5801 prior...
...nally recommend against HLA–B*5801 tes...
...patients with a prior allergic response to...
...ebuxostat
...h gout taking febuxostat with a history of CVD...
...ricosurics
...nts considered for, or taking uricosu...
...ts taking uricosuric treatment, we conditionall...
...en to consider switching to a new ULT strat...
...with gout taking their first XOI monotherapy...
...ients with gout where XOI, uricosurics, and oth...
...h gout for whom XOI, uricosurics, and ot...
...e 6. Gout flare mana...
...atients experiencing a gout flare,...
...en colchicine is the chosen agent,...
...xperiencing a gout flare for whom othe...
...patients who may receive NPO, we st...
...xperiencing a gout flare, we condit...
...gement of lifestyle factors...
...patients with gout, regardless of disea...
...nts with gout, regardless of disease acti...
...r patients with gout, regardless of disea...
...weight/obese patients with gout, regardl...
...h gout, regardless of disease activi...
Table 8. Management of concurrent medicati...
...r patients with gout, regardless of disease acti...
...onditionally recommend choosing losartan...
...nditionally recommend against stopping...
...tionally recommend against adding or switc...