ACR's latest gout treatment guide: 7 types of cases hasten to take medication, eat less 3 types of food, 42 detailed recommendations!

▎ Yao Ming Kant content team editor gout is one of the most common arthritis.however, the management habits and medication compliance of many patients with hyperuricemia are not good.for patients, it is very important to manage hyperuricemia and gout.after 8 years, the American Society of Rheumatology (ACR) issued guidelines for the treatment of gout (2020 Edition), updating the latest clinical evidence since the 2012 edition of the guidelines.the guideline has brought 42 detailed recommendations from the aspects of acute gout attack control, daily lowering of uric acid and prevention of attack, lifestyle management, drug use of combined diseases, etc., and focused on the standard standard treatment of uric acid reduction therapy (serum uric acid < 6mg / dl, about 360 μ mol / L).first author of the guide, rheumatologist John Dr. Fitzgerald pointed out that there are several highlights in this version of the guideline: it expands the range of people who need to start antiuricemia treatment. Allopurinol is recommended as the first-line antiuricemedicine. For drug safety, the people who recommend HLA-B * 5801 test before allopurinol treatment also expand the screenshot. Source: the main treatment suggestions of ACR are as follows: acute gout attack treatment. For gout attack, autumn Narcissus is recommended Alkali, non steroidal anti-inflammatory drugs or glucocorticoids (oral, intra-articular or intramuscular) are used as the first-line treatment.(strongly recommended) if colchicine is used, low dose rather than high dose will have little difference in curative effect and fewer adverse reactions.(highly recommended) glucocorticoid therapy (intramuscular, intravenous or intra-articular) is preferred for patients who are unable to take oral medication.(highly recommended) if the above three kinds of anti-inflammatory drugs are ineffective or intolerable, IL-1 inhibitors or ACTH should be used in addition to adjuvant therapy.(conditional recommendation) when gout attacks, local ice compress should be used as an adjuvant treatment.(conditionally recommended)} when gout is acute, the feet, especially the toes, are particularly painful (photo source: pixabay) patients with gout who have any of the following conditions should start uric acid lowering therapy: Patients with gout stones, with imaging evidence of gout related lesions, or frequent acute attacks (more than 2 times a year).(highly recommended) patients who have had an acute attack and whose frequency is less than 2 times a year can start uric acid lowering therapy. Patients with moderate to severe chronic kidney disease (≥ grade 3), marked hyperuricemia (serum urate & gt; 9 mg / dl, about 540 μ mol / L) or renal calculi should be treated with hypouricemia even if they have occasional gout or first gout attack.(conditional recommendation) for patients without the above complications, uric acid lowering therapy may not be started temporarily after the first acute gout attack.(conditionally recommended) patients with asymptomatic hyperuricemia may not start the uric acid lowering therapy.(conditional recommendation) if you decide to start uric acid lowering therapy when you have an acute gout attack, you should start medication at the same time of anti-inflammatory, not after the acute attack.(conditionally recommended) allopurinol is recommended as the first-line antiuricemedicine, including patients with moderate to severe chronic kidney disease (≥ grade 3).(highly recommended) allopurinol or fenbutamol, not probenecid, is recommended for patients with moderate to severe chronic kidney disease (≥ grade 3). (highly recommended) the new type of uric acid lowering drug pegloticase is not recommended as the first-line treatment. (highly recommended) according to the latest clinical trial data, it is recommended to adopt uric acid reduction therapy for all gout patients. The treatment strategy is to start with low-dose uric acid lowering drugs and gradually increase the dosage to achieve and maintain the serum uric acid level below 6mg / dl, rather than simple fixed dose treatment. this helps to reduce the risk of treatment-related adverse reactions, as well as the risk of acute gout attack. (highly recommended) long term medication is required after the start of uric acid lowering therapy. (conditionally recommended) reduce uric acid and use drugs for acute attack prevention, including colchicine, non steroidal anti-inflammatory drugs or glucocorticoids. (highly recommended) after the initiation of uric acid lowering therapy, preventive medication should be continued for at least 3-6 months, and continuous evaluation should be made. If the patient needs to experience acute attack, the preventive medication should be continued as needed. (highly recommended) it is recommended to test HLA-B * 5801 gene before allopurinol treatment for some Asian (such as Han, Korean, Thai) and African Americans (the above population has a high carrying rate of this gene, which is related to allopurinol allergy). oppose the test in other ethnic groups. (conditionally recommended) allopurinol desensitization therapy can be used if other drugs are not available and allergic to allopurinol. (conditional recommendation) in case of cardiovascular problems, it is recommended that patients with non bustard should use other uric acid lowering drugs if they meet the requirements. (conditionally recommended) patients receiving uric acid excretion drugs do not need to check urine uric acid level or alkalize urine. (conditionally recommended) patients who take antiuricemia drugs (including allopurinol and febuxostat) with unsatisfactory efficacy at the maximum dose, including the substandard serum uric acid level, frequent gout episodes (≥ 2 times / year) or poor control of gout stones, it is recommended to use another uric acid inhibitor instead of adding uric acid excretion drugs. (conditional recommendation) if the drugs that inhibit the production of uric acid, excrete uric acid and other interventions fail (the situation is the same as above), a new type of uric acid lowering drug prekexi should be used. however, if the serum uric acid level is not up to the standard, gout attack is less than 2 times / year, or there is no gout stone, there is no need to use prekeshi. (highly recommended) photo source: 123rf lifestyle management shut up: regardless of the severity of the disease, gout patients should limit alcohol intake, high purine food intake, and high fructose / corn syrup intake. vitamin C supplementation is not recommended. (conditionally recommended) open legs: Overweight gout patients should lose weight regardless of the severity of the disease. (conditionally recommended) combination of disease medication with hypertension: Losartan is preferred. if you are taking hydrochlorothiazide, use other antihypertensive drugs if possible. (conditional recommendation) combined with cardiovascular problems: if you are taking aspirin, do not stop. (conditional recommendation) combined with hyperlipidemia: fenofibrate can be used or added. (recommended with conditions)