A guideline for gout management originally published in 2007 has been revised and updated. Strongly emphasized in the latest version of the British Society for Rheumatology/British Health Professionals in Rheumatology guideline are patient education and providing information about gout and its treatment.
Guideline authors Michelle Hui and colleagues in the United Kingdom offered 4 reasons why there’s a clear need for an update:
(1) New drug treatment options have expanded efficacy and safety profiles.
(2) Gout incidence, prevalence, and severity have increased.
(3) Fewer than half of patients with gout receive urate-lowering treatment.
(4) The barriers to patients with gout receiving adequate care can be overcome.
The authors presented the gout update in a recent Rheumatology article. Following are highlights of their recommendations.
Acute gout attacks
• Educate patients to treat gout attacks as soon as they occur and throughout the attack.
• Advise patients that joints affected by gout should be rested, elevated, and cooled. Bed-cages and ice packs may be useful.
• Use a maximally dosed NSAID with colchicine dosed at 500 μg 2 to 4 times a day, the drugs of choice, in the absence of contraindications. Drug choice depends on patient preference, kidney function, and comorbidities. Prescribe gastroprotective agents for patients receiving NSAIDs.
• Aspirate and inject a joint with corticosteroids for acute single-joint gout. This may be the best treatment in patients with acute attacks and comorbidities. A possible alternative: a short course of oral corticosteroid or a single injection of an intramuscular steroid. Systemic steroid therapy is also appropriate for single or multiple joint attacks.
• Combine treatments for patients with acute gout where monotherapy has failed.
• Consider interleukin-1 inhibitors for patients who don’t respond to standard treatment.
Modifying risk factors and lifestyle
• Consider an alternative blood pressure–lowering agent when diuretics are used to treat hypertension and not heart failure, provided the agent controls the hypertension.
Michelle Hui, Alison Carr, Stewart Cameron, et al. “The British Society for Rheumatology Guideline for the Management of Gout.” Rheumatology (Oxford). 2017 Jun 12. doi: 10.1093/rheumatology/kex250. [Epub ahead of print]