ACR Publishes New Guidelines for the Management of Gout

May 12, 2020

The American College of Rheumatology (ACR) has published new guidelines for the management of gout.

The updated guideline, published in Arthritis Care & Research, reflects new clinical evidence that became available since the ACR last released a treatment guideline for the condition in 2012.

“With this update, we sought to look at new and emerging clinical evidence that would be beneficial for treating patients with gout,” said John FitzGerald, MD, University of California Los Angeles, Los Angeles, California. “The guideline now includes expanded indications for starting urate lowering therapy, a greater emphasis to use allopurinol as the first line agent for all patients with gout that require urate lowering therapy, including those patients with chronic kidney disease, and broadened recommendations about who needs HLA-B*5801 testing prior to starting allopurinol.”

A highlight of the updated guideline is a strong recommendation to use a treat-to-target strategy with urate lowering therapy (ULT) for all patients with gout, based on data from newer clinical trials. The guideline suggests a management strategy of starting with a low-dose of a ULT medication and escalating the dosage to achieve and maintain a serum urate level of ● Indications for starting ULT have been expanded to conditionally consider patients with infrequent gout flares or after their first gout flare if they also have moderate to severe chronic kidney disease (CKD stage ≥3), marked hyperuricemia (serum urate >9 mg/dl) or kidney stones.
● A conditional recommendation against initiating ULT for patients experiencing their first gout flare without above comorbidities.
● A strong recommendation to use allopurinol as the first-line ULT, including in patients with CKD.
● A strong recommendation to use an anti-inflammatory prophylaxis when starting ULT for at least 3 to 6 months rather than less than 3 months, with ongoing evaluation and continued prophylaxis as needed if the patient continues to experience flares.
● A conditional recommendation for HLA-B*5801 testing prior to starting allopurinol for patients of Southeast Asian descent and African American descent who have a higher prevalence of HLA-B*5801 and against HLA-B*5801 testing in patients of other ethnic or racial backgrounds.


SOURCE: American College of Rheumatology