Recognition of ACR Guidelines
The Gout Education Society supports the American College of Rheumatology (ACR) Guidelines for the Management of Gout.
While all medical professionals are able—and encouraged—to take advantage of education and resources available from the Gout Education Society, to be eligible for inclusion in the medical professional locator for patients, you must adhere to the ACR Guidelines for the treatment and management of gout.
The ACR Guidelines are divided into two main sections, with the main points below.
Part One: Systematic Non-pharmacologic and Pharmacologic Therapeutic Approaches to Hyperuricemia
Education on diet, lifestyle, treatment objectives and management of comorbidities should be provided to the patient.
Urate-lowering therapy (ULT) with a Xanthine oxidase inhibitor (XOI) should be used as first line treatment.
The patient’s serum uric acid (sUA) levels should be monitored regularly—GES recommends every six months—and targeted to 6.0 mg/dL or below in all patients (and below 5.0 mg/dL in advanced disease).
Starting allopurinol dose should be no greater than 100 mg/day (and less than that in moderate/severe chronic kidney disease) with gradual upward titration until the target is achieved.
A combination of one XOI and a uricosuric agent is appropriate if the target sUA level cannot be achieved by the XOI alone.
Pegloticase is appropriate when a patient with severe gout is refractory to or intolerant of oral ULT options.
Part Two: Therapy and Anti-inflammatory Prophylaxis of Acute Gouty Arthritis
Acute gout symptoms should be treated pharmacologically within 24 hours of onset for maximum benefit.
Established urate-lowering therapy should be continued, without interruption, during an acute flare.
NSAIDs, glucocorticoids and oral colchicine are appropriate first-line therapies for an acute flare. Combinations can be used.
Anti-inflammatory prophylaxis should be used in all gout patients prior to initiating ULT—and should be continued for three-six months and even longer if flares persist.
Oral colchicine or NSAIDs are appropriate first-line prophylactic therapy—adjusting for chronic kidney disease, drug interactions, poor tolerance or medical contraindications. advanced disease).
