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Current management of gout: practical messages from 2016 EULAR guidelines.

George Nuki, Michael Doherty, Pascal Richette

    Polish Archives of Internal Medicine
    |April 22, 2017
    PubMed
    Summary

    Updated gout management guidelines emphasize patient education, lifestyle changes, and prompt urate-lowering therapy (ULT). The goal is to maintain serum urate (SU) levels below 6 mg/dl to prevent flares and manage comorbidities effectively.

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    Area of Science:

    • Rheumatology
    • Clinical Practice Guidelines
    • Gout Management

    Background:

    • The European League Against Rheumatism (EULAR) published updated gout management recommendations in 2016.
    • Gout management involves patient education, lifestyle modifications, and effective treatment strategies.
    • Understanding gout pathophysiology, comorbidities, and treatment principles is crucial for effective clinical practice.

    Purpose of the Study:

    • To summarize the key principles and recommendations for gout management from the 2016 EULAR guidelines.
    • To highlight the importance of patient education regarding gout pathophysiology and treatment options.
    • To outline the recommended approaches for managing acute gout flares and long-term urate-lowering therapy (ULT).

    Main Methods:

    • The study is based on the 2016 EULAR updated recommendations for gout management.

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  • Key recommendations cover patient education, lifestyle advice, comorbidity screening, acute flare treatment, and urate-lowering therapy (ULT).
  • Specific treatment options and target serum urate (SU) levels are detailed.

    • Main Results:

    • Patient education on gout, comorbidities, and treatments is essential.
    • Management includes addressing lifestyle factors and screening for comorbidities.
    • Treatment for flares involves colchicine, NSAIDs, or steroids; interleukin-1 blockers for specific cases.
    • Urate-lowering therapy (ULT) should be initiated early, targeting SU levels below 6 mg/dl (or 5 mg/dl for severe gout).
    • Allopurinol is the first-line ULT, with alternatives like febuxostat or uricosurics if targets are unmet.
    • Flare prophylaxis during ULT initiation is recommended.
    • Pegloticase is an option for refractory gout.

    Conclusions:

    • Effective gout management requires a comprehensive approach including patient education, lifestyle adjustments, and timely ULT.
    • Achieving and maintaining target serum urate (SU) levels is critical for preventing gout flares and managing the disease.
    • The guidelines provide a clear framework for clinicians to optimize gout patient care, from acute flare management to long-term disease control.