Guidance for Gout

Gout management outlined in new ACR recommendations

/ Author:  / Reviewed by: Joseph V. Madia, MD

(RxWiki News) When a gout attack begins, the pain starts suddenly and can be crushing. To help doctors and patients prevent these attacks, the American College of Rheumatology (ACR) has issued new guidelines for dealing with gout.

The ACR gout guidelines provide patients with useful ways to stop gout attacks and offer recommendations to doctors on treatments for long-term management of the painful condition.

"Gout can be managed - Ask your doctor."

Gout is a type of arthritis that affects almost 4 percent of American adults. It occurs when levels of uric acid rise to a point in which crystals form and lodge in the joints, leading to pain and swelling.

Gout attacks can be debilitating and have a huge impact on patients' quality of life, said John D. Fitzgerald, MD, PhD, of the University of California, Los Angeles.

To improve patient care, the ACR supported a task force panel - including Dr. Fitzgerald - to form new guidelines that outline drug treatments and non-drug treatments to manage gout.

The task force - which included rheumatology experts, primary care doctors, a kidney specialist and a patient representative - looked at research dating back to the 1950s to produce the two-part gout guidelines.

The first part of the guidelines addresses ways to treat hyperuricemia, or high levels of uric acid in the body. The recommendations include:

  • Educating patients on diet, lifestyle choices, treatment goals and managing other diseases that can occur with gout
  • Using a type of drug called xanthine oxidase inhibitor (XOI) as a first-line treatment to lower uric acid levels; Zyloprim (allopurinol) is one example of an XOI
  • First dose of allopurinol should not be more than 100 milligrams a day, and less for patients with chronic kidney disease; over time, allopurinol dose can be gradually increased to be more than 300 milligrams, even in patients with chronic kidney disease
  • Improving gout symptoms by lowering patients' urate levels to at least 6 mg/dL
  • Screening patients with a high risk of negative side effects from allopurinol; high-risk patients may include Koreans with severe kidney disease and patients with a Han Chinese or Thai background
  • Using a drug-combo of one XOI and one uriocosuric agent if initial XOI treatment is not effective

The second part of the guidelines addresses the treatment of gouty arthritis, or the inflammatory aspect of gout. The recommendations include:

  • Starting drug treatment within 24 hours of the first gout attack
  • Continuing non-stop urate-lowering treatment during gout attacks
  • Using non-steroidal anti-inflammatory drugs (NSAIDs), steroids or Colcrys (colchicine) as first-line treatment for acute gout; a combination of these drugs may need to be used for patients with severe gout or who do not respond to single drugs
  • Using colchicine or low-dose NSAIDs to prevent gout attacks when patients are starting urate-lowering treatment

According to Dr. Fitzgerald, the ACR gout guidelines focus on safety, quality of treatment and the best methods for managing gout based on research up to this point.

"Our goal is that these guidelines, along with educating gout patients in effective treatment, will improve [drug] adherence, quality of care and management of this pain and potentially chronically debilitating condition," he said.

The guidelines were published in Arthritis Care & Research, a journal of the ACR.

Reviewed by: 
Review Date: 
September 28, 2012
Last Updated:
September 30, 2012