HealthDay News — New approaches to gout management are presented in a two-part guideline issued by the American College of Rheumatology (ACR) in Arthritis Care & Research.

In part one, Dinesh Khanna, MD, from the University of Michigan in Ann Arbor, and colleagues from the ACR reviewed the literature to examine the systematic nonpharmacologic and pharmacologic recommendations for management of hyperuricemia. The authors provide general health, diet and lifestyle measures for all gout patients.

The recommendations state that a xanthine oxidase inhibitor, such as allopurinol, should be considered the first-line urate-lowering pharmacological approach to reduce urate levels to less than 6 mg/dL. The recommended initial dose should not exceed 100 mg/day and should be less for patients with moderate to severe chronic kidney disease. Screening for HLA-B*5801 should be considered for patients at high-risk of allopurinol reactions. When target urate levels are not achieved, combination therapy is recommended with one xanthine oxidase inhibitor and one uricosuric agent. For uricosuric monotherapy, probenecid is the first-choice agent.

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In part two, Khanna and colleagues review management approaches for treatment and prophylaxis for acute gout attacks. They recommend initiating pharmacologic therapy within 24 hours of attack onset. Urate-lowering therapy should be continued during attacks.

First-line treatment options for acute gout include use of one or a combination of non-steroidal anti-inflammatory drugs (NSAIDs), corticosteroids, or oral colchicine. When initiating urate-lowering therapy, oral colchicine or low-dose NSAIDs should be used as anti-inflammatory prophylaxis to prevent acute gout attacks.

“Our goal is that these guidelines, along with educating gout patients in effective treatment, will improve adherence, quality of care, and management of this painful and potentially chronically debilitating condition,” the researchers wrote.


  1. Khanna D et al. Arthritis Care Res. 2012; 64(10):1431-1461.