Rheumatology Guideline for the Management of Gout
(Part 5)
We now continue our discussion on the guidelines in the management of gout.
Experts recommend the use of concomitant anti-inflammatory prophylaxis therapy for 3–6 months with ongoing evaluation and continued prophylaxis as needed if the patient continues to experience gout flares:
Experts say when a decision is made to use urate lowering therapy (ULT) while the patient is experiencing a gout flare, starting ULT during the gout flare over starting ULT after the gout flare has resolved is conditionally recommended.
It has been shown that starting ULT during a flare has conceptual benefits, including the time efficiency offered by initiating therapy during the concurrent flare episodes.
Furthermore, experts say that patients are likely to be highly motivated to take ULT due to the symptoms related to the current gout flare.
However, concerns about starting ULT during a flare may include potential worsening of a flare, as well as the possibility of information overload for patients, which may lead to gout mismanagement.
Two small randomized control trials and an observational study support the hypothesis that starting ULT during a flare does not significantly extend flare duration or severity.
We need to consider the possibility of patient factors or preferences that would reasonably support the need to delay ULT initiation.
Experts recommend using a treat-to-target management strategy to optimize patient outcomes.
We will tackle additional evidence when it comes to using treat-to-target strategies in the management of gout in our next issue.