David H. Wesorick, MD; Vineet Chopra, MD, MSc
Disclosures: Dr. Chopra reports grants from the Agency for Healthcare Research and Quality. Dr. Wesorick has disclosed no conflicts of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M16-1400.
The American College of Physicians (ACP) recommends synovial fluid analysis for diagnosis of acute gout. Although some clinical algorithms that have more than 80% sensitivity and specificity for acute gout, they are less accurate than synovial fluid analysis and evidence that they effectively rule out joint sepsis is limited.
The ACP recommends that colchicine (low dose), nonsteroidal anti-inflammatory drugs (NSAIDs), or corticosteroids be used to treat acute gout.
It recommends against use of long-term urate-lowering therapy in most patients after a first gout attack or in patients with infrequent attacks (e.g., <2/y), noting that the risks and benefits of this therapy are uncertain.
The guideline notes that using urate-lowering medications to achieve a specific serum urate level is not based on strong evidence and thus does not endorse this approach (in contrast to the American College of Rheumatology guideline). One editorial defends this recommendation, noting that the ACP guideline is based solely on scientific evidence and that its recommendations are not influenced by expert opinion or consensus. Another editorial argues that “treat-to-target” is the most rational approach, based on observational data, experience, and practical factors.
High-quality evidence supports the use of low-dose colchicine or NSAID prophylaxis during initiation of urate-lowering therapy to prevent disease flares.
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David H. Wesorick, Vineet Chopra. Annals for Hospitalists - 17 January 2017. Ann Intern Med. 2017;166:HO1. doi: 10.7326/AFHO201701170
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Published: Ann Intern Med. 2017;166(2):HO1.
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