Gout Treatment Guidelines Revamped After New Clinical Guidance

The updated 2020 guidelines from the American College of Rheumatology focus on establishing a standard treat-to-target urate lowering therapy.

3:08 PM

Author | Jordyn Imhoff

drawing of stethoscope
Image by Stephanie King.

Since the American College of Rheumatology last released the treatment guidelines for gout in 2012, new clinical evidence based on the latest clinical trials has prompted releasing updated guidelines that will improve patient care for the affected population. Standardization of a treat-to-target strategy for urate lowering therapy is the key focus because of its benefit for all patients with gout.

Gout, the most common form of inflammatory arthritis, is a painful, potentially disabling condition caused by having too much uric acid in the body. Uric acid buildup causes chronic inflammation leading to damage in the joints.

"The guidelines include expanded implications for starting urate lowering therapy and a greater emphasis to use allopurinol as the first line agent for all patients with gout that require urate lowering therapy, including those patients with chronic kidney disease," says Puja Khanna, M.D., MPH, a rheumatologist at Michigan Medicine. "It also broadened recommendations about who needs HLA-B*5801 testing prior to starting allopurinol." HLA-B*5901 is a genetic risk factor in specific populations.

The new guidelines recommend a management strategy of starting with a low-dose of a urate lowering medication and increasing the dosage to achieve and maintain a serum urate level of less than 6 mg/dL. This strategy, compared to the 2012 fixed-dose strategy, reduces the risk of treatment-related adverse effects, like flares and other side effects. Other recommendations include:

  • Using an anti-inflammatory prophylaxis (e.g., colchicine, NSAIDs, prednisone/prednisolone) when starting urate lowering therapy for at least three to six months rather than less than three months.
  • Considering urate lowering therapy for patients with infrequent gout flares or after their first gout flare if they also have moderate to severe chronic kidney disease (greater than or equal to stage three), marked hyperuricemia (serum urate greater than 9 mg/dL) or kidney stones.

The guidelines were developed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology. The updated and expanded recommendations can be viewed at American College of Rheumatology.

More Articles About: Lab Notes Health Care Delivery, Policy and Economics Arthritis Rheumatology
Health Lab word mark overlaying blue cells
Health Lab

Explore a variety of health care news & stories by visiting the Health Lab home page for more articles.

Media Contact Public Relations

Department of Communication at Michigan Medicine

[email protected]


Stay Informed

Want top health & research news weekly? Sign up for Health Lab’s newsletters today!

Featured News & Stories drawing of pills in blue ink with lab note written on bottom right in yellow and navy blue
Health Lab
Patient Support Programs for Painful Conditions May Reduce Opioid Use
Study in people taking a biologic drug for autoimmune diseases shows association of patient support programs with reduced chance of starting opioid pain medicines or continuing on them.
two women, one older one younger, looking concerned listening to a provider across from them with back to camera
Health Lab
Many breast cancer survivors don't receive genetic testing, despite being eligible
As cancer treatment and survivorship care relies more on understanding the genetic make up of an individual’s tumor, a study from the University of Michigan Health Rogel Cancer Center finds that many breast cancer survivors who meet criteria for genetic counseling and testing are not receiving it.
Text over image of University of Michigan Health aerial campus
News Release
U-M Health ranked among nation’s best in more specialties than any other Michigan hospital by U.S. News & World Report
University of Michigan Health ranks among the nation’s best hospitals in more specialties than any other Michigan hospital, according to U.S. News and World Report’s Best Hospitals Rankings for 2024-2025.
Health Lab Podcast in brackets with a background with a dark blue translucent layers over cells
Health Lab Podcast
Addressing health care inequality
An expert on racial and ethnic differences in health care and health outcomes offers recommendations as part of a national committee.
woman sitting at table in stripe shirt stressed seeming white background window
Health Lab
An unequal toll of financial stress
Inflation rates may have cooled off recently, but a poll shows many older adults are experiencing financial stress – especially those who say they’re in fair or poor physical health or mental health
sunscreen blue people outside
Health Lab
Sunscreen dispensers make skin cancer prevention easier
Medical students have worked to place dispensers at parks, pools and golf courses around Washtenaw County to give people easy access to sunscreen.