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2020 American College of Rheumatology Guideline for the Management of Gout.
Arthritis Care Res (Hoboken). 2020 Jun; 72(6):744-760.AC

Abstract

OBJECTIVE

To provide guidance for the management of gout, including indications for and optimal use of urate-lowering therapy (ULT), treatment of gout flares, and lifestyle and other medication recommendations.

METHODS

Fifty-seven population, intervention, comparator, and outcomes questions were developed, followed by a systematic literature review, including network meta-analyses with ratings of the available evidence according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology, and patient input. A group consensus process was used to compose the final recommendations and grade their strength as strong or conditional.

RESULTS

Forty-two recommendations (including 16 strong recommendations) were generated. Strong recommendations included initiation of ULT for all patients with tophaceous gout, radiographic damage due to gout, or frequent gout flares; allopurinol as the preferred first-line ULT, including for those with moderate-to-severe chronic kidney disease (CKD; stage >3); using a low starting dose of allopurinol (≤100 mg/day, and lower in CKD) or febuxostat (<40 mg/day); and a treat-to-target management strategy with ULT dose titration guided by serial serum urate (SU) measurements, with an SU target of <6 mg/dl. When initiating ULT, concomitant antiinflammatory prophylaxis therapy for a duration of at least 3-6 months was strongly recommended. For management of gout flares, colchicine, nonsteroidal antiinflammatory drugs, or glucocorticoids (oral, intraarticular, or intramuscular) were strongly recommended.

CONCLUSION

Using GRADE methodology and informed by a consensus process based on evidence from the current literature and patient preferences, this guideline provides direction for clinicians and patients making decisions on the management of gout.

Links

PMC Free PDF

Authors+Show Affiliations

FitzGerald JD
University of California, Los Angeles and VA Greater Los Angeles Health Care System, Los Angeles, California.
Dalbeth N
University of Auckland, Auckland, New Zealand.
Mikuls T
University of Nebraska Medical Center and VA Nebraska-Western Iowa Health Care System, Omaha, Nebraska.
Brignardello-Petersen R
McMaster University, Hamilton, Ontario, Canada.
Guyatt G
McMaster University, Hamilton, Ontario, Canada.
Abeles AM
New York University School of Medicine, New York City, New York.
Gelber AC
Johns Hopkins University, Baltimore, Maryland.
Harrold LR
University of Massachusetts Medical School, Worcester Massachusetts, and Corrona, Waltham, Massachusetts.
Khanna D
University of Michigan, Ann Arbor.
King C
North Mississippi Medical Center, Tupelo.
Levy G
Kaiser Permanente, Downey, California.
Libbey C
Boston University School of Medicine, Boston, Massachusetts.
Mount D
VA Boston Healthcare System, Boston, Massachusetts.
Pillinger MH
New York University School of Medicine, New York City, New York.
Rosenthal A
Medical College of Wisconsin, Milwaukee.
Singh JA
University of Alabama at Birmingham and Birmingham Veterans Affairs Medical Center, Birmingham.
Sims JE
Atlanta, Georgia.
Smith BJ
Florida State University College of Medicine School of Physician Assistant Practice, Tallahassee.
Wenger NS
University of California, Los Angeles.
Bae SS
University of California, Los Angeles.
Danve A
Yale University, New Haven, Connecticut.
Khanna PP
University of Michigan, VA Ann Arbor Healthcare System, Ann Arbor.
Kim SC
Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
Lenert A
University of Kentucky, Lexington.
Poon S
US Department of Veterans Affairs, Manchester, New Hampshire.
Qasim A
McMaster University, Hamilton, Ontario, Canada.
Sehra ST
Mount Auburn Hospital, Cambridge, Massachusetts.
Sharma TSK
Allegheny Health Network, Pittsburgh, Pennsylvania.
Toprover M
New York University School of Medicine, New York City, New York.
Turgunbaev M
American College of Rheumatology, Atlanta, Georgia.
Zeng L
McMaster University, Hamilton, Ontario, Canada.
Zhang MA
Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
Turner AS
American College of Rheumatology, Atlanta, Georgia.
Neogi T
Boston University School of Medicine, Boston, Massachusetts.

MeSH

HumansDisease ManagementGoutHealthy LifestyleSymptom Flare UpUricosuric AgentsNetwork Meta-Analysis as TopicSystematic Reviews as Topic

Pub Type(s)

Journal Article
Practice Guideline

Language

eng

PubMed ID

32391934

Clinical Trial Links

the Effects of Febuxostat Dose Tapering in Gout Patients Optimally Controlled for 5 Years or More
Developing A Gout Action Plan in Primary Care Setting in Singapore

Citation

FitzGerald, John D., et al. "2020 American College of Rheumatology Guideline for the Management of Gout." Arthritis Care & Research, vol. 72, no. 6, 2020, pp. 744-760.
FitzGerald JD, Dalbeth N, Mikuls T, et al. 2020 American College of Rheumatology Guideline for the Management of Gout. Arthritis Care Res (Hoboken). 2020;72(6):744-760.
FitzGerald, J. D., Dalbeth, N., Mikuls, T., Brignardello-Petersen, R., Guyatt, G., Abeles, A. M., Gelber, A. C., Harrold, L. R., Khanna, D., King, C., Levy, G., Libbey, C., Mount, D., Pillinger, M. H., Rosenthal, A., Singh, J. A., Sims, J. E., Smith, B. J., Wenger, N. S., ... Neogi, T. (2020). 2020 American College of Rheumatology Guideline for the Management of Gout. Arthritis Care & Research, 72(6), 744-760. https://doi.org/10.1002/acr.24180
FitzGerald JD, et al. 2020 American College of Rheumatology Guideline for the Management of Gout. Arthritis Care Res (Hoboken). 2020;72(6):744-760. PubMed PMID: 32391934.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - 2020 American College of Rheumatology Guideline for the Management of Gout. AU - FitzGerald,John D, AU - Dalbeth,Nicola, AU - Mikuls,Ted, AU - Brignardello-Petersen,Romina, AU - Guyatt,Gordon, AU - Abeles,Aryeh M, AU - Gelber,Allan C, AU - Harrold,Leslie R, AU - Khanna,Dinesh, AU - King,Charles, AU - Levy,Gerald, AU - Libbey,Caryn, AU - Mount,David, AU - Pillinger,Michael H, AU - Rosenthal,Ann, AU - Singh,Jasvinder A, AU - Sims,James Edward, AU - Smith,Benjamin J, AU - Wenger,Neil S, AU - Bae,Sangmee Sharon, AU - Danve,Abhijeet, AU - Khanna,Puja P, AU - Kim,Seoyoung C, AU - Lenert,Aleksander, AU - Poon,Samuel, AU - Qasim,Anila, AU - Sehra,Shiv T, AU - Sharma,Tarun Sudhir Kumar, AU - Toprover,Michael, AU - Turgunbaev,Marat, AU - Zeng,Linan, AU - Zhang,Mary Ann, AU - Turner,Amy S, AU - Neogi,Tuhina, Y1 - 2020/05/11/ PY - 2019/12/10/received PY - 2020/2/28/accepted PY - 2020/5/12/pubmed PY - 2020/10/3/medline PY - 2020/5/12/entrez PY - 2023/10/10/pmc-release SP - 744 EP - 760 JF - Arthritis care & research JO - Arthritis Care Res (Hoboken) VL - 72 IS - 6 N2 - OBJECTIVE: To provide guidance for the management of gout, including indications for and optimal use of urate-lowering therapy (ULT), treatment of gout flares, and lifestyle and other medication recommendations. METHODS: Fifty-seven population, intervention, comparator, and outcomes questions were developed, followed by a systematic literature review, including network meta-analyses with ratings of the available evidence according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology, and patient input. A group consensus process was used to compose the final recommendations and grade their strength as strong or conditional. RESULTS: Forty-two recommendations (including 16 strong recommendations) were generated. Strong recommendations included initiation of ULT for all patients with tophaceous gout, radiographic damage due to gout, or frequent gout flares; allopurinol as the preferred first-line ULT, including for those with moderate-to-severe chronic kidney disease (CKD; stage >3); using a low starting dose of allopurinol (≤100 mg/day, and lower in CKD) or febuxostat (<40 mg/day); and a treat-to-target management strategy with ULT dose titration guided by serial serum urate (SU) measurements, with an SU target of <6 mg/dl. When initiating ULT, concomitant antiinflammatory prophylaxis therapy for a duration of at least 3-6 months was strongly recommended. For management of gout flares, colchicine, nonsteroidal antiinflammatory drugs, or glucocorticoids (oral, intraarticular, or intramuscular) were strongly recommended. CONCLUSION: Using GRADE methodology and informed by a consensus process based on evidence from the current literature and patient preferences, this guideline provides direction for clinicians and patients making decisions on the management of gout. SN - 2151-4658 UR - https://www.unboundmedicine.com/medline/citation/32391934/full_citation DB - PRIME DP - Unbound Medicine ER -
Grapherence [↓374 ↑115]

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