2020 American College of Rheumatology Guideline for the Management of Gout

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 dev...

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Published in:Arthritis & rheumatology (Hoboken, N.J.) N.J.), 2020-06, Vol.72 (6), p.879-895
Main Authors: FitzGerald, John D., Dalbeth, Nicola, Mikuls, Ted, Brignardello‐Petersen, Romina, Guyatt, Gordon, Abeles, Aryeh M., Gelber, Allan C., Harrold, Leslie R., Khanna, Dinesh, King, Charles, Levy, Gerald, Libbey, Caryn, Mount, David, Pillinger, Michael H., Rosenthal, Ann, Singh, Jasvinder A., Sims, James Edward, Smith, Benjamin J., Wenger, Neil S., Bae, Sangmee Sharon, Danve, Abhijeet, Khanna, Puja P., Kim, Seoyoung C., Lenert, Aleksander, Poon, Samuel, Qasim, Anila, Sehra, Shiv T., Sharma, Tarun Sudhir Kumar, Toprover, Michael, Turgunbaev, Marat, Zeng, Linan, Zhang, Mary Ann, Turner, Amy S., Neogi, Tuhina
Format: Article
Language:English
Subjects:
Allopurinol
Allopurinol - standards
Anti-Inflammatory Agents, Non-Steroidal - standards
Colchicine
Colchicine - standards
Febuxostat - standards
Flares
Glucocorticoids
Gout
Gout - drug therapy
Gout Suppressants - standards
Humans
Kidney diseases
Literature reviews
Management
Nonsteroidal anti-inflammatory drugs
Prophylaxis
Quality
Rheumatology - standards
Titration
United States
Uric acid
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Summary: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 (
ISSN:2326-5191
2326-5205
DOI:10.1002/art.41247