Journal article
2020 American College of Rheumatology Guideline for the Management of Gout
Arthritis care & research (2010), Vol.72(6), pp.744-760
06/2020
DOI: 10.1002/acr.24180
PMCID: PMC10563586
PMID: 32391934
Abstract
Objective: To provide guidance for the management of gout, including indications for and optimal use of urate-lowering therapy (ULT), treatment of gout flares, and lifestyle and other medication recommendations. Methods: Fifty-seven population, intervention, comparator, and outcomes questions were developed, followed by a systematic literature review, including network meta-analyses with ratings of the available evidence according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology, and patient input. A group consensus process was used to compose the final recommendations and grade their strength as strong or conditional. Results: Forty-two recommendations (including 16 strong recommendations) were generated. Strong recommendations included initiation of ULT for all patients with tophaceous gout, radiographic damage due to gout, or frequent gout flares; allopurinol as the preferred first-line ULT, including for those with moderate-to-severe chronic kidney disease (CKD; stage >3); using a low starting dose of allopurinol (≤100 mg/day, and lower in CKD) or febuxostat (<40 mg/day); and a treat-to-target management strategy with ULT dose titration guided by serial serum urate (SU) measurements, with an SU target of <6 mg/dl. When initiating ULT, concomitant antiinflammatory prophylaxis therapy for a duration of at least 3–6 months was strongly recommended. For management of gout flares, colchicine, nonsteroidal antiinflammatory drugs, or glucocorticoids (oral, intraarticular, or intramuscular) were strongly recommended. Conclusion: Using GRADE methodology and informed by a consensus process based on evidence from the current literature and patient preferences, this guideline provides direction for clinicians and patients making decisions on the management of gout.
Details
- Title: Subtitle
- 2020 American College of Rheumatology Guideline for the Management of Gout
- Creators
- John D. FitzGerald - University of California, Los Angeles and VA Greater Los Angeles Health Care System Los Angeles CaliforniaNicola Dalbeth - University of AucklandTed Mikuls - University of Nebraska Medical CenterRomina Brignardello‐Petersen - McMaster UniversityGordon Guyatt - McMaster UniversityAryeh M. Abeles - New York University School of Medicine New York City New YorkAllan C. Gelber - Johns Hopkins UniversityLeslie R. Harrold - University of Massachusetts Medical SchoolWorcester Massachusetts, and Corrona Waltham MassachusettsDinesh Khanna - University of MichiganCharles King - North Mississippi Medical CenterGerald Levy - Kaiser PermanenteCaryn Libbey - Boston University School of MedicineDavid Mount - VA Boston Healthcare SystemMichael H. Pillinger - New York University School of Medicine New York City New YorkAnn Rosenthal - Medical College of WisconsinJasvinder A. Singh - University of Alabama at BirminghamJames Edward Sims - Atlanta GeorgiaBenjamin J. Smith - Florida State University College of Medicine School of Physician Assistant Practice TallahasseeNeil S. Wenger - University of California Los AngelesSangmee Sharon Bae - University of California Los AngelesAbhijeet Danve - University of New HavenPuja P. Khanna - University of MichiganVA Ann Arbor Healthcare System Ann ArborSeoyoung C. Kim - Brigham and Women's HospitalAleksander Lenert - University of KentuckySamuel Poon - US Department of Veterans Affairs Manchester New HampshireAnila Qasim - McMaster UniversityShiv T. Sehra - Mount Auburn HospitalTarun Sudhir Kumar Sharma - Allegheny Health NetworkMichael Toprover - New York University School of Medicine New York City New YorkMarat Turgunbaev - American College of RheumatologyLinan Zeng - McMaster UniversityMary Ann Zhang - Brigham and Women's HospitalAmy S. Turner - American College of RheumatologyTuhina Neogi - Boston University School of Medicine
- Resource Type
- Journal article
- Publication Details
- Arthritis care & research (2010), Vol.72(6), pp.744-760
- DOI
- 10.1002/acr.24180
- PMID
- 32391934
- PMCID
- PMC10563586
- NLM abbreviation
- Arthritis Care Res (Hoboken)
- ISSN
- 2151-464X
- eISSN
- 2151-4658
- Language
- English
- Date published
- 06/2020
- Academic Unit
- Immunology; Internal Medicine
- Record Identifier
- 9984359837102771
Metrics
117 Record Views