Gout is one of the most common forms of inflammatory arthritis, affecting nearly 4% of adult Americans. Newly approved guidelines that educate patients in effective methods to prevent gout attacks and provide physicians with recommended therapies for long-term management of this painful disease are published in Arthritis Care & Research, a peer-reviewed journal of the American College of Rheumatology (ACR).
Uric acid is produced by the metabolism of purines, which are found in foods and human tissue. When uric acid levels increase, crystals can form and deposit in joints, causing excruciating pain and swelling typical of an acute gout flare. Doctor-diagnosed gout has risen over the past 20 years and now affects 8.3 million individuals in the U.S., according to a July 2011 study published in Arthritis & Rheumatism. Medical evidence suggests that the increased prevalence of elevated uric acid levels (hyperuricemia) and gout may be attributed to such factors as hypertension, obesity, metabolic syndrome, type 2 diabetes, and the extensive treatment with thiazide and loop diuretics for cardiovascular disease.
"Acute gout attacks can be debilitating and adversely affect patients' quality of life," says lead investigator John D. Fitzgerald, MD, PhD, Acting Rheumatology Division Chief at the University of California, Los Angeles (UCLA). "In order to improve patient care, the ACR funded this collaborative effort among U.S. researchers to produce guidelines, outlining pharmacological therapies and non-drug treatments to manage gout."
Dr. Fitzgerald and fellow co-leaders Drs. Robert Terkeltaub (senior and corresponding author, from the VA and UCSD system), Dinesh Khanna and Puja P. Khanna (from the University of Michigan and VA system) reviewed medical literature from the 1950s to the present. A task force panel including seven rheumatologists, two primary care physicians, a nephrologist, and a patient representative then ranked and voted upon recommendations to create the two-part ACR gout guidelines.
Part I guidelines focus on the systematic non-pharmacologic and pharmacologic therapeutic approaches to hyperuricemia and include:
Part II guidelines cover therapy and prophylactic anti-inflammatory treatment for acute gouty arthritis. These guidelines recommend that physicians:
Dr. Fitzgerald concludes, "The ACR gout guidelines are designed to emphasize safety, quality of therapy, and to reflect best practice based upon medical evidence available at this time. Our goal is that these guidelines, along with educating gout patients in effective treatment, will improve adherence, quality of care and management of this painful and potentially chronically debilitating condition."
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