Recently, the American College of Rheumatology (ACR) released the 2012 edition of its gout management guidelines to guide physicians and patients on how to better cope with gout. The guidelines are divided into two parts.
Part I:Pharmacologic and non-pharmacologic management of gout
Foundational recommendations for gout management
1.Patients with gout should learn reasonable eating habits and lifestyle habits
2.Factors causing secondary hyperuricemia need to be avoided
3.Avoid the use of drugs that cause uric acid increase unless necessary
4, need to assess the severity of gout (whether there are gout stones, the number of gout attacks, etc.)
Suggestions for uric acid-lowering drug therapy
1.All gout patients diagnosed with gout stones can be treated with uric acid-lowering drugs (allopurinol, etc.)
2.Patients with frequent gout attacks (more than or equal to 2 attacks per year) can also use these drugs
3. Patients with gout combined with chronic kidney disease (stage 2 or above) or who have had urinary stones in the past are also recommended to use these drugs.
4. The minimum treatment goal is to reduce serum urea levels to less than 6 mg/dl, and to less than 5 mg/dl would be ideal
5. Allopurinol or febuxostat is recommended as the first-line uric acid-lowering drug
6. Combination of uric acid-lowering drugs and anti-inflammatory drugs should be considered if gout has attacked
7. The starting dose of allopurinol should not exceed 100 mg/day, or 50 mg/day if combined with chronic kidney disease (stage 4 or above). Dose may be increased every 2 to 5 weeks until serum uric acid reaches target therapeutic level
1. Propofol is the best choice to promote uric acid excretion
2. If uric acid levels are persistently elevated, a combination of a xanthine oxidase inhibitor (allopurinol or busulfan) and a drug that promotes uric acid excretion (e.g., probenecid) may be considered
Dietary recommendations
Researchers have divided food recommendations into three categories: avoid, restrict, and encourage. Objectively, these recommendations were derived from certain isolated clinical studies, rather than large-scale multicenter clinical studies or meta-analyses. Researchers also disagree on the recommendations for certain foods (cherries, nuts and legumes).
Avoid: animal offal rich in purines, sweetened beverages high in fructose and soft drinks. Avoid alcohol during gout attacks, and strict alcohol restrictions are needed during non-attacks.
Limit consumption of: beef, lamb, pork, seafood high in purines (sardines and shellfish), naturally very sweet juices, salt and alcohol (especially beer)
Encourage consumption of: low-fat dairy products and vegetables
Part II: Treatment recommendations during acute gout attack
1.Start medication within 24 hours of an acute gout attack
2.Uric acid-lowering drugs need to continue to be taken
3.Non-steroidal anti-inflammatory drugs (NSAID), glucocorticoids and oral colchicine are the first-line recommended medications during acute gout attacks. If the attack is severe, a combination of these drugs may be used. However, the combination of NSAID and glucocorticoids is not recommended because the gastrointestinal side effects of these two to be superimposed and there are some risks
1.Ice can be applied externally in the painful joints
2. To prevent gout attacks, NSAID or colchicine can be used at the same time as uric acid-lowering treatment. If these two drugs are contraindicated or not tolerated by the patient, glucocorticoid replacement such as prednisone can be considered.