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2020 American College of Rheumatology Guideline for the Management of Gout
Author(s) -
FitzGerald John D.,
Dalbeth Nicola,
Mikuls Ted,
BrignardelloPetersen Romina,
Guyatt Gordon,
Abeles Aryeh M.,
Gelber Allan C.,
Harrold Leslie R.,
Khanna Dinesh,
King Charles,
Levy Gerald,
Libbey Caryn,
Mount David,
Pillinger Michael H.,
Rosenthal Ann,
Singh Jasvinder A.,
Sims James Edward,
Smith Benjamin J.,
Wenger Neil S.,
Bae Sangmee Sharon,
Danve Abhijeet,
Khanna Puja P.,
Kim Seoyoung C.,
Lenert Aleksander,
Poon Samuel,
Qasim Anila,
Sehra Shiv T.,
Sharma Tarun Sudhir Kumar,
Toprover Michael,
Turgunbaev Marat,
Zeng Linan,
Zhang Mary Ann,
Turner Amy S.,
Neogi Tuhina
Publication year - 2020
Publication title -
arthritis care and research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.032
H-Index - 163
eISSN - 2151-4658
pISSN - 2151-464X
DOI - 10.1002/acr.24180
Subject(s) - medicine , gout , febuxostat , guideline , allopurinol , physical therapy , concomitant , population , intensive care medicine , rheumatology , uric acid , hyperuricemia , pathology , environmental health
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.