New Gout Treatment Guidelines From The American College Of Rheumatology

Content

• Gout And Pseudogout Treatment & Management
• Pseudogout
• Understanding Treatments For Gout
• Current Pharmacologic Options For Acute Gouty Inflammation

Dual-energy CT scans can also reveal uric acid deposits and can be useful if the diagnosis is unclear based on standard clinical evaluation and testing, particularly if synovial fluid aspiration and analysis cannot be done. Radiographs of joints affected by acute gout attacks typically are not useful for the diagnosis of acute gout. The dose should be increased every 3-4 weeks, while monitoring blood urate level – aiming for a fall of under 0.04 mmol/L each month and eventual level below 0.36 mmol/L.

Gout And Pseudogout Treatment & Management

Ask your prescribing provider if you are at risk for severe allopurinol reactions. Side effects are far less extensive than other uric acid-reducing drugs and may include rash and stomach upset. Stomach problems usually go away as your body adjusts to the medication.

Diuretics are used commonly for hypertension, for example, and they elevate the blood levels of uric acid and can increase the risk of gout. Patients with a first gout episode should not start urate-lowering therapy, except if they have moderate-to-severe chronic kidney disease, kidney stones, or serum urate above 9 mg/dL. This group was given a conditional recommendation to start uric acid-lowering therapy. Vitamin C, with its uricosuric effect, may reduce the serum concentration of uric acid. In one study, 500 mg/day for 2 months reduced uric acid by a mean of 0.5 mg/dL in patients without gout. However, gout patients appear to be less responsive to such a low dose of ascorbate.

Pseudogout

Pseudogout is usually treated with chronic antiinflammatory therapy as needed, and possibly colchicine to decrease the frequency of attacks and to treat attacks when they occur. Uric acid-lowering therapy is not effective for pseudogout, Dr. Mandell said. Previous participation in the CONTACT trial during a previous acute attack of gout. Pseudogouthas similar symptoms to gout and is often confused with gout. Like gout, it is caused when painful crystals form in the joints. Unlike gout , pseudogout happens when there is too much calcium in the body.

Probenecid is not safe to take for many people with kidney disease, so talk to your doctor for more information about probenecid. Get physically active.Experts recommend that adults engage in 150 minutes per week of at least moderate physical activity. Every minute of activity counts, and any activity is better than none. Moderate, low impact activities recommended include walking, swimming, or biking. Regular physical activity can also reduce the risk of developing other chronic diseases such as heart disease, stroke, and diabetes.

Management Of Gout In Patients With Renal Transplant

Some have called for the FDA to reconsider its recommendations, but no changes made to date. The FAST trial gives considerable comfort to those patients presently on febuxostat. It is generally agreed that we have no evidence that febuxostat is a negative for the heart, just the question of the CARES trial as to whether it is not as protective as allopurinol. The FAST trial challenges this, and it may well be that they are equally protective.

What foods are bad for gout?

Foods to Avoid if You Have GoutBeer and grain liquors (like vodka and whiskey)
Red meat, lamb, and pork.
Organ meats, such as liver, kidneys, and glandular meats like the thymus or pancreas (you may hear them called sweetbreads)
Seafood, especially shellfish like shrimp, lobster, mussels, anchovies, and sardines.

"If there is no strong evidence that answers the clinical question, then maybe the guideline is not the place to find every answer." The ACR's 2012 guidelines were published prior to the new IOM standard for guideline development but "serve the purpose of a best practice recommendation for gout management" and can provide physicians with advice, Dr. McLean said. Because there is no high-quality evidence, the ACP guideline committee could not endorse a treat-to-target strategy. The committee was aware that this finding would not be well received by many in the rheumatology community and was braced for the resulting controversy, Dr. McLean added. "The ACP is not drawing a line in the sand. We are saying what the data indicate, and because we are following the strict directives on what a guideline should be based upon, we can't say more than this," he said.

While historically it is not recommended to start allopurinol during an acute attack of gout, this practice appears acceptable. Allopurinol blocks uric acid production, and is the most commonly used agent. Long term therapy is safe and well-tolerated and can be used in people with renal impairment or urate stones, although hypersensitivity occurs in a small number of individuals.

Does soaking in hot water help gout?

Soaking in cold water is most often recommended and considered most effective. Ice packs may also work. Soaking in hot water is typically only recommended when inflammation isn't as intense. Alternating hot and cold applications may also be helpful.

Nonsteroidal anti-inflammatory drugs are contraindicated with the concomitant use of angiotensin-converting enzyme inhibitors and/or diuretics. Prostaglandin production is decreased while using NSAIDs, resulting in increased constriction of afferent renal arterioles and decreased glomerular filtration pressure. This physiologic effect of NSAIDs can be exacerbated when used in combination with ACE inhibitors or diuretics, both of which can also reduce glomerular filtration pressures.

Most people with hyperuricemia never develop gout, and people with gout may have varying levels of uric acid in their blood. It is important to see a doctor if you experience gout symptoms. With treatment you may be able to control the disease and prevent joint damage. High uric acid levels may cause kidney stones and, sometimes, damage the kidneys. ACP’s clinical practice guidelines are developed through a rigorous process based on an extensive review of the highest quality evidence available, including randomized control trials and data from observational studies. ACP also identifies gaps in evidence and direction for future research through its guidelines development process.

This summary is provided to assist in informed clinical decisionmaking. However, reviews of evidence should not be construed to represent clinical recommendations or guidelines. Sometimes during an acute gout attack, uric acid levels may test normal because the uric acid has left your bloodstream and entered the inflamed tissue. If you do have a high uric acid level during a gout attack, it is likely that the level was even higher before the attack. To help diagnose gout, your doctor may check your blood uric acid levels in between attacks to see if they run high.

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