Best Practice Case Studies-Clinical Guideline on Gout 2012

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The 2012 American College of Rheumatology (ACR) guidelines address the management of gout, focusing on both nonpharmacologic and pharmacologic treatments for hyperuricemia. Gout is caused by excess uric acid in the body, leading to urate crystal deposition and arthritis. This article describes pharmacologic approaches, emphasizing the need for a holistic strategy that includes lifestyle modifications and specific medical treatments.<br /><br />Key nonpharmacologic recommendations involve lifestyle and dietary adjustments, such as reducing alcohol and purine-rich food intake, and encouraging low-fat dairy consumption. Also emphasized is the importance of patient education on gout management to improve treatment adherence and outcomes.<br /><br />Pharmacologic treatments focus on urate-lowering therapy (ULT). Allopurinol and febuxostat, as xanthine oxidase inhibitors (XOIs), are recommended first-line options to lower uric acid levels, with starting doses of allopurinol no more than 100 mg/day. In patients with chronic kidney disease, doses should be adjusted with careful monitoring. Probenecid, a uricosuric drug, is suggested as an alternative but generally not for those with significant renal impairment.<br /><br />The guidelines recommend achieving a serum urate level of less than 6 mg/dl, and potentially below 5 mg/dl, to reduce gout symptoms effectively. Allopurinol toxicity management includes HLA–B*5801 testing in specific high-risk populations (e.g., certain Asian ethnicities) to prevent hypersensitivity reactions.<br /><br />When first-line treatments fail, combining XOIs with uricosurics like probenecid or losartan is advised. Pegloticase is suggested for patients intolerant to standard therapies, especially in those with severe gout. Continuous clinical evaluation is recommended to tailor treatments effectively to patient needs.<br /><br />The ACR guidelines provide a comprehensive framework for managing gout, highlighting the importance of adjusting the treatment plan as needed for individual patient circumstances and emerging evidence.

Meta Tag

Edition 2nd Edition

Related Case 2nd Edition, CASE 45

Topic Rheumatology

Keywords

2nd Edition, CASE 45

2nd Edition

Rheumatology

gout management

hyperuricemia

lifestyle modifications

urate-lowering therapy

allopurinol

febuxostat

probenecid

serum urate levels

HLA–B*5801 testing

ACR guidelines