New recommendations of the American College of Rheumatology for the patient management with gout (2020). Review on some points

Abstract

In May 2020, the updated recommendations of the American College of Rheumatology on the patient management with gout were published. The focus was on the indications for urate-lowering therapy (ULT) and its optimal use, treatment of gout flares, and the importance of lifestyle. A consensus based on current literature and patient preferences resulted in 42 recommendations. The sixteen highly recommended provisions included the following: ULT should be prescribed to all patients with tophi, radiological signs of joint damage or frequent gout flares; allopurinol should be preferred as a ULT first-line drug, including for patients with chronic kidney disease (CKD) above stage III; ULT regimen should begin at a low initial dose of allopurinol (<100 mg/day and below in CKD) or febuxostat (<40 mg/day); the treatment tactics should achieve the goal with dose titration under the control of the serum uric acid (SUA) level to maintain <6 mg/dL (<360 mmol/L). At the beginning of treatment, concomitant anti-inflammatory prophylactic therapy of at least 3–6 months was strongly recommended. Colchicine, nonsteroidal anti-inflammatory drugs or glucocorticoids (oral, intra-articular, or intramuscular) were suggested for the treatment of gout flares. The purpose of this publication was to inform physicians decision-making on the gout treatment about the patient management algorithm and the need to achieve the target level of SUA to prevent flares and complications of the disease. KEYWORDS: gout, hyperuricemia, clinical recommendations, urate-lowering therapy, diet, lifestyle, food, treatment. FOR CITATION: Gromova M.A., Tsurko V.V. New recommendations of the American College of Rheumatology for the patient management with gout (2020). Review on some points. Russian Medical Inquiry. 2021;5(2):89–95. DOI: 10.32364/2587-6821-2021-5-2-89-95.