medwireNews: The American College of Rheumatology (ACR) has issued updated guidelines for the management of gout.
“Since the 2012 ACR gout guidelines, several clinical trials have been conducted that provide additional evidence regarding the management of patients with gout, leading the ACR Guidelines Subcommittee to determine that new guidelines were warranted,” say the guideline authors, led by Tuhina Neogi (Boston University School of Medicine, Massachusetts, USA).
The 2020 recommendations were compiled using GRADE methodology, and a group consensus process based on evidence from published studies and patient preferences was used to generate a total of 42 recommendations, including 16 strong recommendations.
Neogi and colleagues say that the strong recommendations include a treat-to-target strategy with urate-lowering therapy (ULT) for all individuals with tophaceous gout, radiographic damage due to gout, or frequent flares, with a goal of maintaining serum urate levels below 6 mg/dL. They recommend allopurinol as the first-line ULT, including in patients with moderate-to-severe chronic kidney disease.
“As data continue to emerge supporting best practices in management, implementation of these recommendations will ideally lead to improved quality of care for patients with gout,” they write.
The guidelines have been published simultaneously in Arthritis Care & Research and Arthritis & Rheumatology.
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Arthritis Care Res 2020; doi:10.1002/acr.24180
Arthritis Rheumatol 2020; doi:10.1002/art.41247