Something Old, Something New: the ACR Gout Treatment Guideline and Its Evolution from 2012 to 2020
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CRYSTAL ARTHRITIS (M PILLINGER & M TOPROVER, SECTION EDITORS)
Something Old, Something New: the ACR Gout Treatment Guideline and Its Evolution from 2012 to 2020 Rebecca E. Cohen 1
&
Michael H. Pillinger 1,2
&
Michael Toprover 1,2,3
Accepted: 15 November 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose of Review Gout is the most common inflammatory arthritis in the USA, affecting about 4% of all adults. The American College of Rheumatology (ACR) released a new guideline in 2020 to help with the management of gout. This guideline serves as an update to the previous set of guidelines which the ACR published in 2012. The purpose of this review is to compare the 2012 ACR gout guidelines to the newly released 2020 ACR gout guidelines. Recent Findings There are many similarities between the two guidelines, and also several key differences. The 2020 guidelines assist in the clinical management of gout by healthcare providers. Additionally, the new guidelines utilize newer literature to help create an evidence-based approach to the treatment for gout. We discuss the methodological approach to each guideline (RAND versus GRADE), as well as the final recommendations for gout flare treatment, use of imaging, urate-lowering therapy, lifestyle changes, and genetic testing prior to initiation of allopurinol in each guideline, as well as lingering issues that the 2020 guidelines have not addressed. Summary We dissect both the 2012 and 2020 ACR gout guidelines to summarize the key similarities and differences between the two as well as discuss how the authors came to the recommendations that they did for each set of guidelines. Keywords Gout . Allopurinol . Febuxostat . Guidelines . Colchicine
Introduction Gout is the most common inflammatory arthritis in the USA, affecting about 4% of adults, with hyperuricemia affecting ~ 20% of adults [1]. Despite a deep biological understanding of the role of hyperuricemia in gout, only about 1/3 of gout patients take urate-lowering therapy (ULT) to manage their gout [1]. To improve the management of this common disease, in 2020 the American College of Rheumatology (ACR) released a new guideline to manage gout [2••]. This guideline This article is part of the Topical Collection on Crystal Arthritis * Michael Toprover [email protected] 1
Division of Rheumatology, NYU Grossman School of Medicine, New York, NY, USA
2
Rheumatology Section, New York Harbor Health Care System, New York Campus, United States Department of Veterans Affairs, New York, NY, USA
3
Division of Rheumatology, NYU Langone Health, 301 East 17th Street, New York, NY 10003, USA
serves as an update to the prior ACR gout treatment guidelines released in 2012 [3, 4]. The purpose of the new guideline is to assist in the clinical management of gout by healthcare providers and serve as an update using newer literature to help create an evidence-based approach to treatment. The current guideline focuses on lifestyle factors that may precipitate gout flares, treating a
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