ACP: New Guideline for Treating Patients with Gout

The American College of Physicians (ACP) has published new guidelines for clinicians managing and treating adults with acute or recurrent gout.1

The ACP’s Clinical Guidelines Committee reviewed randomized controlled trials, systematic reviews, and large observational studies published between January 2010 and March 2016, and evaluated the evidence using the ACP grading system.
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The final guideline includes 4 recommendations that yielded high- and moderate-quality evidence:

  1. Treatments for acute gout include corticosteroids, nonsteroidal anti-inflammatory drugs (NSAIDs), or colchicine. (High-quality evidence)
  2. When using colchicine to treat acute gout, clinicians should use low-dose colchicine. (Moderate-quality evidence)
  3. Clinicians should not use long-term urate-lowering therapy in most patients who have had a first gout attack or in patients with infrequent attacks. (Moderate-quality evidence)
  4. Before initiating urate-lowering therapy, including concomitant prophylaxis, in patients with recurring gout attacks, clinicians should discuss the benefits, harms, costs, and individual preferences of the therapy. (Moderate-quality evidence)

In addition, the Committee noted inconclusive evidence several areas:

  • Treatment strategy for patients with gout who are receiving urate-lowering therapy
  • Effect of urate-lowering therapy on adverse health outcomes beyond acute gout
  • Duration of urate-lowering therapy
  • Treatment in different patient groups
  • Effect of dietary therapies
  • Long-term effect of febuxostat.

Notably, the guidelines contrast with 2012 recommendations published by the American College of Rheumatology, which call for the lowering of serum uric acid levels below 357 µmol/L.2

—Amanda Balbi

Reference:

  1. Qaseem A, Harris RP, Forciea MA; Clinical Guidelines Committee of the American College of Physicians.  Management of acute and recurrent gout: a clinical practice guideline from the American College of Physicians [published online November 1, 2016]. Ann Intern Med. doi:10.7326/M16-0570.
  2. Khanna D, Fitzgerald JD, Khanna PP, et al. 2012 American College of Rheumatology guidelines for management of gout. Part 1: Systematic nonpharmacologic and pharmacologic therapeutic approaches to hyperuricemia. Arthritis Care Res. 2012;64(10):1431–1446.