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ACR task force establishes new guidelines for patients with gout

Patient education for those diagnosed with gout and the first American College of Rheumatology guidelines for therapy and anti-inflammatory prophylaxis of acute gout attacks are among the recommendations of a two-part management program developed and endorsed by the organization.

The guidelines, targeting systematic nonpharmacologic and pharmacologic strategies for reducing hyperuriciema and treatment of acute gouty arthritis, were established by an American College of Rheumatology (ACR) task force panel (TFP). The panel comprised seven rheumatologists, two primary care physicians, a nephrologist and a patient representative. After reviewing literature from PubMed and Cochrane Central Register of Controlled Trials from the 1950s to the present, the TFP ranked and voted for recommendations for the 2012 ACR gout guidelines.

Part 1 focused on urate-lowering therapy (ULT) and chronic gouty arthritis with tophaceous disease detected via physical examination. Recommendations to control hyperuricemia include:

• Educating patients to avoid, limit or encourage consumption of specific foods
• Promoting healthy lifestyle choices
• Prescribing xanthine oxidase inhibitors (XOI), including allopurinol or febuxostat, as a first-line ULT, with initial doses no greater than 100 mg daily (lower for patients with chronic kidney disease) and gradually increased to 300 mg daily
• Striving to reduce patients’ urate levels to a minimum of less than 6 mg/mL to relieve gout symptoms
• Considering prescreening of patients at high risk for severe adverse reaction to allopurinol by polymerase chain reaction HLA–B*5801 testing
• Treating patients with combination therapy of one XOI and one uriocosuric agent (probenecid) if target urate levels are not met

Part 2 focuses on therapy and anti-inflammatory prophylaxis for acute gouty arthritis and calls for physicians to:

• Initiate treatment with pharmacologic therapy within 24 hours of onset
• Maintain ULT during acute gout flares
• Prescribe corticosteroids, NSAIDs or oral colchicine as first-line treatment options, or use a combination of these drugs for refractory or severe cases
• Employ low-dose NSAIDs or oral colchicine as first-line options to prevent gout attacks when ULT is initiated, provided there is no intolerance or medical contraindication

“The ACR guidelines for ULT in gout and for treatment and anti-inflammatory prophylaxis of gouty arthritis … will require updating as new evidence emerges for appropriate evaluation and management of gout,” the researchers wrote. “It is hoped that publication of these guidelines, along with effective patient education in gout treatments … will improve patient adherence, quality of care, and outcomes in management of gout.”

The researchers noted that these recommendations do not include any subsequent therapies approved or diet and lifestyle measures studied after the original literature review.

Disclosure: See the studies for a full list of relevant disclosures.