CRYSTAL DEPOSITION DISEASES: Edited by Robert TerkeltaubEvolution of management of gout a comparison of recent guidelinesKhanna, Puja P.a; FitzGerald, JohnbAuthor Information aDivision of Rheumatology, University of Michigan, Ann Arbor, Michigan bDavid Geffen School of Medicine, UCLA, Los Angeles, California, USA Correspondence to Puja P. Khanna, MD, MPH, Division of Rheumatology, Department of Internal Medicine, 300 North Ingalls, Ste. 7C27, Ann Arbor, MI 48109-5422, USA. Tel: +1 734 763 9151; fax: +1 734 763 1253; e-mail: [email protected] Current Opinion in Rheumatology: March 2015 - Volume 27 - Issue 2 - p 139-146 doi: 10.1097/BOR.0000000000000154 Buy Metrics Abstract Purpose of review There have been several guidelines on the management of gout over the last decade; however, inconsistencies between them create confusion for practitioners. This review highlights areas of agreement between guidelines and discusses data where disagreements exist. Recent findings For acute gout, the guidelines agree that anti-inflammatory treatment should start as soon as possible, preferably within 24 hours. Older guidelines preferred NSAIDs or colchicine over steroids, but newer ones leave the choice of agent to the physician. For colchicine, all guidelines recommend using low dose. Intra-articular, oral or intramuscular steroids are all described as effective. For management of hyperuricemia, indications for initiating urate-lowering therapy (ULT) have become more inclusive over the years by requiring lower burden of disease severity or including patient comorbidities. Probenecid has fallen out of favour with most guidelines favouring allopurinol over febuxostat. Although there is a disagreement about timing of initiation for ULT, guidelines recommend treating to target of serum urate (sUA) less than 6 mg/dl, and less than 5 mg/dl for patients with more severe disease. Concurrent anti-inflammatory prophylaxis has gained strong support over the years. Summary Most guidelines are in agreement with recommendations for management of gout and most changes have been directional and evolutionary. Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.