Gout Guidelines Issued

The American College of Rheumatology has published new gout management guidelines in Arthritis Care & Research.

Among the recommendations with the highest levels of evidence for pharmacologic treatment of hyperuricemia:

• Allopurinol or febuxostat should be first-line therapy. If these are contraindicated, probenecid is an alternative.

• Serum urate levels should be targeted to at least <6 mg/dL.

• When the target hasn't been met, treatment should be titrated upward to the maximum appropriate dose (up to 800 mg/day for allopurinol, 120 mg for febuxostat).

• HLA-B*5801 allele testing is recommended for patients at high risk for severe allopurinol sensitivity (e.g., those of Hans Chinese or Thai descent). Patients who test positive may receive an alternative to allopurinol.

Among the recommendations for preventing and treating acute gouty arthritis:

• Monotherapy with NSAIDs, corticosteroids, or oral colchicine is recommended for mild-to-moderate gout attacks.

• Colchicine should be the first-line therapy for attack prophylaxis (with, or just before initiating, urate-lowering therapy).

• Prophylaxis should continue for the greater of: 6 months, 3 months after achieving target urate levels without tophi, or 6 months after achieving target levels with resolution of tophi.