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EULAR releases 2016 gout management guidelines
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In a recently published report, the EULAR has updated its 2006 gout management recommendations with 11 key points.
Colchicine or NSAIDs were recommended for the treatment of flares alone or in combination, but for patients with contraindication to colchicine, NSAIDs and corticosteroids were advised. At first presentation of the disease, urate-lowering therapy (ULT) was suggested in addition to patient education with target serum uric acid (SUA) levels of less than 6 mg/dL. The recommendations noted a target of less than 5 mg/dL for patients with severe disease. Advised patient education included lifestyle changes, such as appropriate avoidance of alcohol, beverages high in sugar, excessive intake of meat and seafood. Patients should be encouraged to exercise and use low-fat dairy products, according to the report.
The first ULT recommended is allopurinol, with dosing adjusted based on renal function. Febuxostat (Uloric, Takeda) combined with a xanthine oxidase inhibitor “should be considered” as a second-line treatment for patients who do not meet SUA level goals. For patients with gout that does not respond to first- and second-line treatments, a combination of allopurinol, febuxostat and a uricosuric were recommended or a combination of a xanthine oxidase inhibitor with a uricosuric were advised.
The panel advised physicians to consider pegloticase (Krystexxa, Horizon Pharma) for patients with refractory gout and crystal-proven, tophaceous gout and poor quality of life. In addition, the committee recommended screening for comorbidities, such as cardiovascular disease, for all patients with gout. The involvement of other care providers was also encouraged.
“As first-line care providers, [general practitioners] GPs have a predominant role in gout treatment. Likewise, the involvement of patients in the management of chronic diseases is crucial,” the researchers wrote. “Therefore, in contrast to 2006, the current task force included two GPs and two patients to broaden the involvement of stakeholders involved in the disease.”
Disclosures: Richette reports fees from Pharma/Menarini, AstraZeneca and Savient. Please see the full study for a list of all other authors’ relevant financial disclosures.
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