New recommendations for gout treatment

  If you are a gout patient, the following recommendations may be of good value for your treatment or condition management: 1. Optimal treatment of gout requires a combination of pharmacologic and non-pharmacologic therapies, adjusted for: (1) specific risk factors (blood uric acid levels, previous attacks and radiographic manifestations); (2) clinical stage (acute/recurrent gout, interictal gout and chronic gouty stone (3) general risk factors (age, gender, obesity, alcohol consumption, uric acid-enhancing drugs, drug interactions and co-morbidities).  2. Patient education and good lifestyle. Weight control, diet control and reduction of alcohol consumption (especially beer) in obese people are the core part of treatment.  3.Comorbid diseases and morbidity-related risk factors such as hyperlipidemia, obesity and smoking should be taken seriously and treated as an important part of gout management.  4.The first-line medication for systemic treatment of acute gout is oral colchicine and/or non-steroidal anti-inflammatory drugs. If not contraindicated, non-steroidal anti-inflammatory drugs are a convenient and easily accepted option.  High doses of colchicine can cause side effects, while low doses of colchicine (e.g., 0.5 mg 3 times daily) are sufficient to control some acute gout.  6.Intra-articular puncture and injection of long-acting hormones are effective and safe for the treatment of acute gout.  7.Patients with recurrent acute gout, arthrosis, gout stone or gout with radiological changes should be treated with uric acid-lowering therapy.  8.The goal of uric acid-lowering therapy is to promote crystal lysis and prevent crystal formation, which requires keeping blood uric acid levels below the saturation point of monosodium urate.  9.Allopurinol is a suitable long-term uric acid-lowering drug. It should be started at a low dose (100 mg/d) and gradually increased by 100 mg every 2-4 weeks if needed. this dose needs to be adjusted according to the patient’s renal impairment. If drug toxicity occurs, other options include other xanthine oxidase inhibitors, drugs to promote uric acid excretion, or desensitization therapy (the latter is only appropriate for mild rash).  10. Uric acid-removing agents such as probenecid and benzbromarone may be used as an alternative to allopurinol in patients with normal renal function, but are relatively contraindicated in the presence of urinary tract stones. Benzbromarone can be used in patients with mild to moderate renal insufficiency, but has a mild risk of causing hepatotoxicity.  11. Colchicine (0.5-1 mg/d) and/or non-steroidal anti-inflammatory drugs can be used to prevent acute gout attacks during the first month of uric acid-lowering therapy.  12. When gout is associated with the use of diuretics, discontinue the use of diuretics if possible. For patients with hypertension and hyperlipidemia consider cloxacin and fenofibrate respectively (both have mild uric acid excretory effects).