Best Practice Case Studies-Clinical Guideline on Gout 2020

Pdf Summary

The 2020 American College of Rheumatology (ACR) guideline for gout management provides comprehensive recommendations intended to improve the quality of care for patients with gout, a common form of inflammatory arthritis. These guidelines emphasize the importance of urate-lowering therapy (ULT) and encourage a treat-to-target approach with frequent monitoring of serum urate levels to achieve a target of 6 mg/dl. Key recommendations include initiating ULT for patients with tophaceous gout, radiographic evidence of gout damage, or frequent gout flares (two or more per year). The guideline recommends allopurinol as the preferred first-line ULT for most cases, including those with chronic kidney disease (CKD), due to its efficacy, safety, and cost-effectiveness compared to other agents like febuxostat and pegloticase.<br /><br />The guideline suggests using a low starting dose for all ULT agents to minimize the risk of gout flares upon initiation. For flare management, colchicine, nonsteroidal anti-inflammatory drugs (NSAIDs), and glucocorticoids are recommended. IL-1 inhibitors and ACTH are reserved for cases where conventional therapies are ineffective or contraindicated. <br /><br />Lifestyle modifications are encouraged, including reducing alcohol, purine, and high-fructose corn syrup intake, alongside weight loss for overweight or obese individuals. While the guideline advises against using uricosurics extensively, it recommends evaluation of concurrent medications that could affect urate levels, such as switching hydrochlorothiazide to an alternative antihypertensive if feasible, and using losartan preferentially.<br /><br />The guideline incorporates patient preferences and emphasizes a shared decision-making process between patients and healthcare providers, particularly for conditional recommendations. This document reflects a significant update from the 2012 guidelines, incorporating new evidence and aiming for actionable practices that align with contemporary clinical trials and methodologies.

Meta Tag

Edition 2nd Edition

Related Case 2nd Edition, CASE 45

Topic Rheumatology

Keywords

2nd Edition, CASE 45

2nd Edition

Rheumatology

gout management

urate-lowering therapy

treat-to-target

allopurinol

colchicine

lifestyle modifications

shared decision-making

American College of Rheumatology

inflammatory arthritis

serum urate levels