Recognition of ACR Guidelines

The Gout & Uric Acid 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 & Uric Acid 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—GUAES 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.

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 until the target sUA level is achieved and gouty symptoms cease.

Oral colchicine or NSAIDs are appropriate first-line prophylactic therapy—adjusting for chronic kidney disease, drug interactions, poor tolerance or medical contraindications. advanced disease).


By checking the box below, I agree to follow and adhere to the ACR Guidelines for the Management of Gout.

I Agree You must agree to adhere to the ACR Guidelines to join the Gout Specialists Network.