The Guideline for the Management of Gout
(Part 1)
This week we start a discussion on the particular guidelines in the management of a rheumatological disease called gout.
There are certain guidelines that are being used by experts to provide guidance for the management of gout, including indications for and optimal use of urate-lowering therapy (ULT), drugs and lifestyle and other drug-related recommendations.
The formulation of the guidelines was based on a systematic literature review (SLR) based on 57 different studies, including network meta-analyses with ratings of the available evidence according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology, and patient input.
A group consensus process was used to determine the final recommendations and assess the recommendations’ strength as either strong or conditional.
As a result, 42 recommendations (including 16 strong recommendations) were produced. Strong recommendations included initiation of ULT for all patients with tophaceous gout, radiographic damage due to gout, or frequent gout.
ULT should be used for those with moderate-to-severe chronic kidney disease (CKD) guided by serial serum urate (SU) measurements, with an SU target of <6 mg/dl.
For the management of gout, colchicine, nonsteroidal anti-inflammatory drugs, or glucocorticoids were strongly recommended.
We will continue with a deeper dive on the guidelines in the management of gout in the next few weeks in this column.