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Evolution of management of gout: a comparison of recent guidelines.
Curr Opin Rheumatol. 2015 Mar; 27(2):139-46.CO

Abstract

PURPOSE OF REVIEW

There have been several guidelines on the management of gout over the last decade; however, inconsistencies between them create confusion for practitioners. This review highlights areas of agreement between guidelines and discusses data where disagreements exist.

RECENT FINDINGS

For acute gout, the guidelines agree that anti-inflammatory treatment should start as soon as possible, preferably within 24 hours. Older guidelines preferred NSAIDs or colchicine over steroids, but newer ones leave the choice of agent to the physician. For colchicine, all guidelines recommend using low dose. Intra-articular, oral or intramuscular steroids are all described as effective. For management of hyperuricemia, indications for initiating urate-lowering therapy (ULT) have become more inclusive over the years by requiring lower burden of disease severity or including patient comorbidities. Probenecid has fallen out of favour with most guidelines favouring allopurinol over febuxostat. Although there is a disagreement about timing of initiation for ULT, guidelines recommend treating to target of serum urate (sUA) less than 6 mg/dl, and less than 5 mg/dl for patients with more severe disease. Concurrent anti-inflammatory prophylaxis has gained strong support over the years.

SUMMARY

Most guidelines are in agreement with recommendations for management of gout and most changes have been directional and evolutionary.

Authors+Show Affiliations

aDivision of Rheumatology, University of Michigan, Ann Arbor, Michigan bDavid Geffen School of Medicine, UCLA, Los Angeles, California, USA.No affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Review

Language

eng

PubMed ID

25611299

Citation

Khanna, Puja P., and John FitzGerald. "Evolution of Management of Gout: a Comparison of Recent Guidelines." Current Opinion in Rheumatology, vol. 27, no. 2, 2015, pp. 139-46.
Khanna PP, FitzGerald J. Evolution of management of gout: a comparison of recent guidelines. Curr Opin Rheumatol. 2015;27(2):139-46.
Khanna, P. P., & FitzGerald, J. (2015). Evolution of management of gout: a comparison of recent guidelines. Current Opinion in Rheumatology, 27(2), 139-46. https://doi.org/10.1097/BOR.0000000000000154
Khanna PP, FitzGerald J. Evolution of Management of Gout: a Comparison of Recent Guidelines. Curr Opin Rheumatol. 2015;27(2):139-46. PubMed PMID: 25611299.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Evolution of management of gout: a comparison of recent guidelines. AU - Khanna,Puja P, AU - FitzGerald,John, PY - 2015/1/23/entrez PY - 2015/1/23/pubmed PY - 2015/9/29/medline SP - 139 EP - 46 JF - Current opinion in rheumatology JO - Curr Opin Rheumatol VL - 27 IS - 2 N2 - PURPOSE OF REVIEW: There have been several guidelines on the management of gout over the last decade; however, inconsistencies between them create confusion for practitioners. This review highlights areas of agreement between guidelines and discusses data where disagreements exist. RECENT FINDINGS: For acute gout, the guidelines agree that anti-inflammatory treatment should start as soon as possible, preferably within 24 hours. Older guidelines preferred NSAIDs or colchicine over steroids, but newer ones leave the choice of agent to the physician. For colchicine, all guidelines recommend using low dose. Intra-articular, oral or intramuscular steroids are all described as effective. For management of hyperuricemia, indications for initiating urate-lowering therapy (ULT) have become more inclusive over the years by requiring lower burden of disease severity or including patient comorbidities. Probenecid has fallen out of favour with most guidelines favouring allopurinol over febuxostat. Although there is a disagreement about timing of initiation for ULT, guidelines recommend treating to target of serum urate (sUA) less than 6 mg/dl, and less than 5 mg/dl for patients with more severe disease. Concurrent anti-inflammatory prophylaxis has gained strong support over the years. SUMMARY: Most guidelines are in agreement with recommendations for management of gout and most changes have been directional and evolutionary. SN - 1531-6963 UR - https://www.unboundmedicine.com/medline/citation/25611299/Evolution_of_management_of_gout:_a_comparison_of_recent_guidelines_ DB - PRIME DP - Unbound Medicine ER -