Journal of Rheumatic Diseases

Table. 1.

Current recommendations for treatment of hyperuricemia in gout patients

Guideline/Reference EULAR (2016) [32] BSR (2017) [33] ACR (2012) [34] ACR (2020 draft) [62]
Current recommendations for asymptomatic hyperuricemia
Lifestyle modification Yes Yes Yes Yes
Urate lowering therapy No No No No
Current recommendations for acute gout
Initiation of treatment As early as possible As early as possible As early as possible As early as possible
Medications NSAIDs, Colchicine, corticosteroid (oral, IM, IV), Combination if needed. Uncontrolled flare up, consider IL-1 blocker
Colchicine reduction* Yes Yes Yes Yes
Topical ice massage Recommend Recommend Recommend Recommend
Current recommendations for chronic gout
Target uric acid <5 mg/dL or<6 mg/dL No less than 3 mg/dL 5 mg/dL <5 mg/dL or <6 mg/dL <5 mg/dL or <6 mg/dL
ULT indications Recurrent flares, tophi, renal stone, arthropathy Even if 1st attack, <40 years, sUA >8 mg/dL, comorbidities Recurrent flares, tophi, CKD arthropathy, urolithiasis, diuretics, young age onset Recurrent flares, tophi, CKD 2, urinary stone Recurrent flares, tophi, radiographic damage. Even if 1st attack, CKD 3, sUA >9 mg/dL, urolithiasis
Commencement of ULT Not mentioned After inflammation During a gout flare During a gout flare
Prophylaxis Colchicine/NSAIDs Colchicine/NSAIDs Colchicine/NSAIDs Colchicine/NSAIDs
Duration of prophylaxis 6 months 6 months 3 months/6 months (tophi) 3 months/6 months (tophi)
HLA-B5801 screening Not mentioned Korean, Han Chinese, Thai Korean, Han Chinese, Thai Korean, Han Chinese and Thai, African American
1st line ULT Allopurinol Allopurinol Allopurinol/Febuxostat Allopurinol
2nd line ULT Febuxostat or Uricosuric agents Febuxostat or Uricosuric agents Probenecid Febuxostat over probenecid
3rd line ULT Pegloticase Pegloticase Pegloticase Pegloticase

EULAR: Eeuropean league against rheumatism, BSR: British society for rheumatology, ACR: American college of rheumatology, NSAIDs: non-steroidal anti-inflammatory drugs, IM: intramuscular, IV: intravenous, IL: interleukin, CKD: chronic kidney disease, ULT: urate-lowering therapy. *Colchicine should be used with caution and at low doses in patients taking drugs that are potent inhibitors of cytochrome P4503A4 (e.g., cimetidine, clarithromycin, erythromycin, fluoxetine, ketoconazole, protease inhibitors, tolbutamide) or p-glycoprotein (e.g., clarithromycin, ciclosporin, erythromycin). A lower serum uric acid (<5 mg/dL) is recommended for patients with severe gout (tophi, chronic arthropathy, frequent attacks) in EULAR group recommendation. The target serum urate level should be lowered to below 5 mg/dL in patients with visible tophi or chronic renal impairment.

J Rheum Dis 2020;27:78~87 https://doi.org/10.4078/jrd.2020.27.2.78
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