2020 American College of Rheumatology Guideline for the Management of Gout

John D. FitzGerald, Nicola Dalbeth, Ted Mikuls, Romina Brignardello-Petersen, Gordon Guyatt, Aryeh M. Abeles, Allan C. Gelber, Leslie R. Harrold, Dinesh Khanna, Charles King, Gerald Levy, Caryn Libbey, David Mount, Michael H. Pillinger, Ann Rosenthal, Jasvinder A. Singh, James Edward Sims, Benjamin J. Smith, Neil S. Wenger, Sangmee Sharon BaeAbhijeet Danve, Puja P. Khanna, Seoyoung C. Kim, Aleksander Lenert, Samuel Poon, Anila Qasim, Shiv T. Sehra, Tarun Sudhir Kumar Sharma, Michael Toprover, Marat Turgunbaev, Linan Zeng, Mary Ann Zhang, Amy S. Turner, Tuhina Neogi

Research output: Contribution to journalArticlepeer-review

30 Scopus citations


Objective: To provide guidance for the management of gout, including indications for and optimal use of urate-lowering therapy (ULT), treatment of gout flares, and lifestyle and other medication recommendations. Methods: Fifty-seven population, intervention, comparator, and outcomes questions were developed, followed by a systematic literature review, including network meta-analyses with ratings of the available evidence according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology, and patient input. A group consensus process was used to compose the final recommendations and grade their strength as strong or conditional. Results: Forty-two recommendations (including 16 strong recommendations) were generated. Strong recommendations included initiation of ULT for all patients with tophaceous gout, radiographic damage due to gout, or frequent gout flares; allopurinol as the preferred first-line ULT, including for those with moderate-to-severe chronic kidney disease (CKD; stage >3); using a low starting dose of allopurinol (≤100 mg/day, and lower in CKD) or febuxostat (<40 mg/day); and a treat-to-target management strategy with ULT dose titration guided by serial serum urate (SU) measurements, with an SU target of <6 mg/dl. When initiating ULT, concomitant antiinflammatory prophylaxis therapy for a duration of at least 3–6 months was strongly recommended. For management of gout flares, colchicine, nonsteroidal antiinflammatory drugs, or glucocorticoids (oral, intraarticular, or intramuscular) were strongly recommended. Conclusion: Using GRADE methodology and informed by a consensus process based on evidence from the current literature and patient preferences, this guideline provides direction for clinicians and patients making decisions on the management of gout.

Original languageEnglish (US)
Pages (from-to)879-895
Number of pages17
JournalArthritis and Rheumatology
Issue number6
StatePublished - Jun 1 2020

ASJC Scopus subject areas

  • Immunology and Allergy
  • Rheumatology
  • Immunology


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