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THURSDAY, May 21, 2020 (HealthDay News) — In an updated American College of Rheumatology guideline, published online May 11 in Arthritis Care & Research<\/i>, recommendations are presented for the management of gout.<\/p>\n
John D. FitzGerald, M.D., Ph.D., from the University of California in Los Angeles, and colleagues conducted a systematic literature review to provide guidance for the management of gout. A total of 42 recommendations were generated, including 16 strong recommendations.<\/p>\n
The authors note that the strong recommendations include urate-lowering therapy (ULT) initiation for all patients with tophaceous gout, radiographic damage due to gout, or frequent gout flares. The preferred first-line ULT is allopurinol, including for those with moderate-to-severe chronic kidney disease. A low starting dose of allopurinol (\u2264100 mg\/day or lower in the case of chronic kidney disease) or febuxostat (\u226440 mg\/day) should be used. In addition, a treat-to-target management strategy should be employed, with titration of ULT guided by serial serum urate measurements, targeting a serum urate of <6 mg\/dL. Concomitant anti-inflammatory prophylaxis therapy is strongly recommended when initiating ULT for a duration of at least three to six months. For patients of Southeastern Asian descent and for African-American patients, testing for the HLA-B*5801 allele is conditionally recommended prior to starting allopurinol. Colchicine, nonsteroidal anti-inflammatory drugs, or glucocorticoids are strongly recommended for the management of gout flares.<\/p>\n
“As data continue to emerge supporting best practices in management, implementation of these recommendations will ideally lead to improved quality of care for patients with gout,” the authors write.<\/p>\n
Several authors disclosed financial ties to the pharmaceutical industry.<\/p>\n