Friday, December 11, 2020

Guidelines for management of gout by ACR 2020


Long time..

Urate-lowering therapy indications and important guidelines for management of gout, as updated by ACR in 2020:

-  recommended in patients with >1 s/c tophi, evidence of damage on radiology, and frequent gout flares (>2 annually).

- comorbid moderate-to-severe (stage >3) CKD with serum urate concentration of >9 mg/dl, or urolithiasis.

- start ULT in patients currently experiencing a gout flare instead of waiting for it to resolve.

- set a target serum uric acid level of <6 mg/dl

-  start with low-dose (<100 mg/dl) allopurinol and febuxostat (<40 mg/dl) -- even lower doses in patients with comorbid CKD; probenecid is the third choice.

- Concomitant anti-inflammatory therapy for 3-6 months  (low-dose colchicine, NSAIDs, prednisone), instead of <3 months previously 

- Second-line: IL-1 inhibitors or ACTH or I.V. glucocorticoids

- Adjuvant treatment with topical ice.

Source - American College of Rheumatology

That's all

- Jaskunwar Singh

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