Uric acid should be preferred for pyropurinol! American Rheumatology Society updates gout guidelines after 8 years

On May 11th the American Society of Rheumatology (ACR) released a new version of the gout treatment guidelinesIt's also an update to the old guide eight years agoThis new guideline sings 42 recommendations on the control of acute gout, the usual reduction of uric acid and the prevention of seizures, lifestyle improvements, medication during comorbidities, and other aspects, with a focus on the standard standard treatment of reducing uric acid (heuric acid 6 mg/dl, approx360 mol/L)" this update builds on the accumulation of new clinical evidenceThe new guidelines expand the evidence for reducing uric acid therapy, recommending desalinol as a first-line uric acid reduction drugThe number of people who recommended HLA-B x 5801 testing prior to treatment of peripurtol was also widenedThe lead author of the guide, rheumatologist John FitzGerald, saidnew guidelines recommend a clinical management strategy that begins at low doses and gradually increases in doses to achieve and maintain levels of hearic acid of 6 mg/dl, rather than being treated at a fixed doseThis practice is primarily intended to reduce the risk of treatment-related adverse reactions, as well as the risk of acute outbreaks of goutother important recommendationsinclude:for those with low or first gout, and if accompanied by moderate to severe chronic kidney disease (CKD 3), hyperuric acidemia (heuric acid - 9 mg/dl) or kidney stones, it is recommended to initiate a treatment to reduce uric acidIn the absence of these complications in patients with the first gout attack, it is not recommended to initiate the treatment to reduce uric acidstrongly recommends depresionol as a first-line uric acid reduction drug, even if the patient is a chronic patient with kidney diseasestrongly recommend that uric acid reduction be accompanied by acute seizure prevention medications, including autumn daffodils, nonsteroidal anti-inflammatory drugs, or glucocorticoids such as pernison/penisonafter starting uric acid reduction therapy, preventive medication lasts at least 3 to 6 months instead of 3 months, and is continuously evaluated, such as acute asthma attack in patients, on-demand on-demand preventive medicationrecommends that some Asians (e.gHan, Korean, Thai) and African-Americans undergo HLA-B x 5801 genetic testing prior to treatment for depresionol (the gene is highly carried in these populations and is associated with a phenosis olpnoster allergy)This test is not recommended for other ethnic groupsin lifestyle management, gout patients should limit their consumption of high-sugar foods and eat less foods containing high fructose or corn syrup, in addition to limiting their intake of high-sorghum foodsVitamin C supplementation is not recommended in the guidelinesin addition, the guidelines also recommend that, regardless of the severity of the disease, gout patients should manage their weight, overweight people to lose weightSource:John DFitz Gerald, et al2020 American College of RheumatoLogy for Management of The GoutArthritis Care and Research, DOI 10.1002/acr.24180"
click on the full textACR releases gout management guidelineEurekalertRetrieved May 11, 2020 Lu Fang Source: