Gout — achieving the management goal

Published on 20 Dec 2019
Last Updated on 14 Dec 2023

This ACE Clinical Guidance (ACG) highlights the pharmacological and non-pharmacological aspects of long-term management of gout, with a focus on urate-lowering therapy (ULT), prophylaxis, and acute flare treatment. Specifically, the ACG offers evidence-based recommendations on initiation of ULT for patients who meet the treatment criteria, provision of prophylaxis during the initial period of ULT, monitoring and risk mitigation for severe cutaneous adverse reactions (SCARs), as well as management of acute flares. Two patient education aids are included to assist discussions between healthcare professionals and patients.

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Gout – achieving the management goal (Dec 2023) [PDF]

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ACG recommendations

1. Initiate urate-lowering therapy (ULT) for patients who meet the ULT treatment criteria, starting at a low dose and slowly titrating upwards as needed.

2. Provide prophylaxis with colchicine; if colchicine is not suitable, consider a low-dose oral nonsteroidal anti-inflammatory drug (NSAID), or a low-dose oral corticosteroid if NSAIDs are not suitable.

3. Mitigate the risk of developing severe cutaneous adverse reactions (SCARs) and provide counselling on SCAR monitoring for patients on allopurinol or febuxostat.

4. Manage acute flares as soon as possible, including treatment with colchicine, NSAIDs, or corticosteroids.

ACG references

Gout – achieving the management goal references (Dec 2023) [PDF]