Comparing the 2012 ACR Gout Treatment Guidelines (ACR Guidelines) and the Chinese Society of Medicine, Rheumatology Branch Gout Treatment Guidelines (Chinese Guidelines), the main differences are as follows: 1. Probenecid was first recommended as a first-line agent, and probenecid was first recommended as a first-line uric acid excretory agent only when it was contraindicated or not tolerated by at least one xanthine oxidase inhibitor;
The Chinese guidelines do not recommend febuxostat, and the Chinese guidelines recommend benzbromarone, which is not recommended by the ACR guidelines (not available in the US). The ACR guidelines prohibit uric acid excretory agents for those with a history of urinary stones and elevated uric acid, while the Chinese guidelines recommend caution for those with a history of urinary stones and no mention for those with elevated uric acid. 2. Time to start uric acid-lowering therapy: ACR guidelines recommend starting uric acid-lowering therapy after the start of effective anti-inflammatory pain relief; Chinese guidelines recommend starting uric acid-lowering therapy after the acute attack has subsided. 3. Testing for B-5801 gene before using allopurinol: ACR guidelines recommend testing for HLA-B5801 gene before treatment with allopurinol in high-risk groups (including Han Chinese) to avoid lethal allergic reactions; Chinese guidelines are not mentioned. 4. Selection of anti-inflammatory analgesics for acute attacks of gouty arthritis: The ACR guidelines recommend NSAIDs, colchicine and glucocorticoids, and the three drugs are recommended equally, and physicians consider them based on patient preference, response to previous treatment, and comorbidities; the Chinese guidelines recommend glucocorticoids for those who cannot tolerate NSAIDs and colchicine or have renal insufficiency. 5. Emphasis on stratified treatment: The ACR guidelines emphasize stratified treatment. In gouty arthritis, the decision to choose monotherapy or combination therapy is based on the degree of pain and the number of joints involved, and recommendations are made for combination therapy programs; the Chinese guidelines do not emphasize stratified treatment. 6. Prevention of gout attacks: ACR
The guideline will small doses of prednisone or prednisolone can be used to prevent gout flares in patients who are intolerant to colchicine and NSAIDs, have contraindications, and are ineffective; the Chinese guideline is not mentioned.