Rheumatology Guideline for the Management of Gout
(Part 3)
Initiating urate-lowering therapy (ULT) is strongly recommended for gout patients with evidence of radiographic damage linked to gout; or frequent gout flares, which happen at least once a year.
This recommendation is based on randomized clinical trials (RCTs) of pegloticase and lesinurad, as there is high certainty of evidence regarding the efficacy of ULT in reducing are frequency of gout problems.
There are experts who reported that they were initially hesitant to start ULT, after experiencing improved control of inflammatory symptoms, they became strong advocates for its earlier use.
Initiating ULT is something that must be conditionally used for patients who have previously experienced gout.
The clinical benefit of ULT would be lower than the ULT benefit for patients with more burdensome gout.
In a single study some patients who were randomized to receive febuxostat (versus placebo) were less likely to experience a subsequent flare of gout.
There are certain conditions such as chronic kidney disease and cardiovascular disease that might influence the risk-benefit assessment and these were considered, but due to insufficient data for some patients.
Experts said there are some conditions that warranted stronger ULT use specific to these subgroups.
Initiating ULT is conditionally recommended against in patients who are experiencing their first episode of gout
It is not recommended to use ULT on patients with moderate to severe chronic kidney disease.
Experts recognized that there may be patients who would prefer to be included in the decision- making when using ULT.
We will continue our discussion on the management of gout in next week’s column.