Panel Issues Consensus Statement on Management of Gouty Arthritis of the Foot and Ankle

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An expert panel evaluated 23 separate statements related to the etiology, diagnosis, and treatment of gout. <i>Credit:DR P. MARAZZI/Science Source</i>
An expert panel evaluated 23 separate statements related to the etiology, diagnosis, and treatment of gout. Credit:DR P. MARAZZI/Science Source

Use of nonsteroidal anti-inflammatory drugs (NSAIDs) for the first-line treatment of gout is “appropriate,” according to a joint clinical consensus statement issued by the American College of Foot and Ankle Surgeons and the American Association of Nurse Practitioners (ACFAS/AANP).

The consensus statement, which included 23 individual statements, was developed by a 7-member panel that included 3 podiatric foot and ankle surgeons and 4 nurse practitioners. The statement was published in The Journal of Foot & Ankle Surgery.

The panel reached consensus about 17 statements, agreeing that 13 were appropriate, 1 was inappropriate, and 3 were neither appropriate nor inappropriate. The panel was unable to reach consensus on 6 other statements.

The panel reached consensus that advanced imaging is unnecessary for diagnosing gout; joint aspiration and microscopy are the gold standards for diagnosing gout; and allopurinol should be titrated until the serum uric acid level is below 6.0 mg/dL.

The panel agreed that the statement “hyperuricemia is always indicative of gout” is inappropriate.

In the “neither appropriate nor inappropriate” category, statements include chemotherapy places a patient at higher risk for gout; patients with a body mass index higher than 27 kg/m2 are at elevated risk for gout; and ethnicity, race, and socioeconomics “play a great role in regard to the incidence of gout.”

The panel could not reach consensus on whether colchicine should be taken daily for 6 to 12 months after acute gouty flares in patients with recurrent gouty attacks, whether patients with diabetes mellitus are at increased risk for gouty flares, and whether joint implant replacement should be considered in cases of chronic gout.

In the guidelines, researchers noted that clinical consensus statements “reflect information synthesized from an organized group of experts based on the best available evidence and to some degree embrace opinions, uncertainties, and minority viewpoints.”

A clinical consensus statement “should open the door to discussion on a topic, as opposed to providing definitive answers.”

Reference

Mirmiran R, Bush T, Cerra MM, et al. Joint clinical consensus statement of the American College of Foot and Ankle Surgeons® and the American Association of Nurse Practitioners: Etiology, diagnosis, and treatment consensus for gouty arthritis of the foot and ankle. J Foot Ankle Surg. 2018;57:1207-1217.

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