According to the ACR guidelines, when is pharmacologic urate-lowering therapy indicated in the treatment of gout?

Updated: Jan 26, 2021
  • Author: Bruce M Rothschild, MD; Chief Editor: Herbert S Diamond, MD  more...
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Answer

The ACR updated its guideline on management of gout in 2020. Recommendations are summarized below. [127]

Indications for pharmacologic urate-lowering therapy:

  • Initiating ULT is strongly recommended for gout patients with ≥1 subcutaneous tophi, evidence of radiographic damage (any modality) attributable to gout, or frequent gout flares (≥2 annually).
  • Initiating ULT is conditionally recommended for patients who have previously experienced >1 flare but have infrequent flares.
  • Initiating ULT is conditionally recommended against in patients with gout experiencing their first gout flare; however, initiating ULT is conditionally recommended for patients with comorbid moderate-to-severe (stage ≥3) chronic kidney disease (CKD), serum urate concentration >9 mg/dL, or urolithiasis.
  • Initiating ULT is conditionally recommended against in patients with asymptomatic hyperuricemia.

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