04/05/2023
Update ααααΈ ααΈααααΊ Gout(αααααααΈα: αααΆααααααΆαααααααΎαα’αΆαααΈαα’αα»ααα·α)
2020 American College of Rheumatology Guideline for the Management of Gout
I: Indications for Pharmacological ULT
αααααααα ααααΌαααααΎααααΆααααα
α»αα’αΆαααΈαα’αα»ααα·ααααα»αααΆαα
α‘.α‘ ααααΆα strongly recommend ααααΌα α±ααααααΎααααΆααααα
α»αα’αΆαααΈαα’αα»ααα·α
αααα»αααΆα ααΆααΎαααααΌαα
ααααα’αααααααΊαααααΆαααααΊαααΆααααααΆαα Gout αααααΆαααααααααΆααΌα
ααΆααααααα
- ααΆα αα»αTophi αα
αααααααααα subcutaneous tophi,
- ααΆαααΌαααΆααααααααΆααααααααααααΆαα (patients with radiographic damage) ααΆααααααΉααααΆααααααΆαα Gout gout
- ααΆαααΆαααΎα‘αΎαααααΊαααΆααααααΆαα gout αααα½α
ααααΆα ααΎα ααΈ α’ αα / ααααΆαα
For patients with frequent gout flares (> 2/year),
α‘.α’ ααααΆα ααΎααΆαααααααΆα Moderate recommend α±ααααααΎααααΆααααα
α»αα’αΆαααΈαα’αα»ααα·α
αααα»αααΆα α
ααααααααΊαααΆααααααΆαα Gout ααΆαααΆαααΎα‘αΎααααα½α
ααααΆα αα·α
ααΆα α’ αααααα»ααα½αααααΆαα For patients who have previously experienced more than one flare but have infrequent flares (< 2/year), we conditionally recommend initiating ULT over no ULT.
α
ααααα’αααααααΊααΆα gout αααα½α
ααααΆααα·α
αα½α
αα·ααα·αααΆα Tophy ααΆαααααΎααααΆααααααΆααααα
α»αα’αΆαααΈαα’αα»ααα·α
αααα»αααΆα ααΊααΆαα’ααααααααααααα·α
ααΆα α’αααααααΊααΆα gout αααα½α
ααααΆα α
αααΎααααααα»ααα½αααααΆαα
α‘.α£ αα·αααααΆαααααΎ conditionally recommended against ααααΆααααα
α»αα’αΆαααΈαα’αα»ααα·α
αααα»αααΆα α
ααααα’αααααααΊαααα»α ααΆα gout αααα½α
ααααΆαα
αααααΈααΆαααΆαααΆααααα ααΆα’αΆα
ααααΌαααΆαααααΆα±ααααααΎ Conditionally Recommend α
ααααα’αααααααΊ: ααααΊααααααααααααα ααααΆααααΆαααΈ α£ CKD > 3 α¬ ααααα·αα’αΆαααΈαα’αα»ααα·ααααα»αααΆαβ₯ α©mg / dl, ααΆααααα½αUrat (urolithiasis)
αααααΆαααααΎ ααααΆααααα
α»αα’αΆαααΈαα’αα»ααα·α
αααα»αααΆα α’αΆα
ααΆααα»αααααααααααααΎα±αα ααΆαααα
α»αααΆααα·ααααααGout, ααΆαααΆααα»αααΆααααααααα ,αααααααΆαααΎααααα½α Urat ααααααααα
α‘.α€ α
ααααα’αααααααΊααααΆααααααΆαααΎαααΆαα· α’αΆαααΈαα’αα»ααα·α
αααα»αααΆα Hyperuricemia ααααααΆα (αα·αααΆααααααααα·ααΊαααααΆαα Guot αααα½α
ααααΆαααΈαα»ααα, ααααΆα subcutaneous tophi ) αα·αααααΆαααααΎ conditionally recommended against ααααΆααααα
α»αα’αΆαααΈαα’αα»ααα·α
αααα»αααΆα α
ααααΎαααΎαααααΆααααα
α»αα’αΆαααΈαα’αα»ααα·ααααα»αααΆαα
2.1 Allopurinol ααΊααΆαααααΎαααααΌαFirst Line ααααΌαααΆαααααΆαα’ααααααΎααααααααααΉαααααΆααααααα αα½αααΆααα’αααααααΊααΆαααααααααααααα (>ααααΆααααΆαααΈ α£) α
2.2 α
ααααα’αααααααΊααΆαααααααααααααααααΆαααα(ααααΆααααΆα α£) ααααΆα allopurinol α¬ febuxostat ααααΌαααΆαααααΆα αααααααααα
ααΉαααααΆα probenecid α
α’.α£ Allopurinol αα·α febuxostat αα½αααααααΌαααΆαα
αΆααααααΎαααααααα·αααΆα (100 mg allopurinol, α¦ mg / dl α’αααααααΊααΆαGuot Flaresαααα½α
ααααΆαααΎα α’ αααααα»ααα½αααααΆαα¬ α’αααααααΊαα·αα’αΆα
αααααααααTophi α
- αα·αααααΌαααΆαααααΆαα’ααααααΌααα
ααααΎ pegloticase ααααααα·αααΎααααΎααααΆα Xanthine Oxidase inhibitor, Uricosurics α’αΆαααΈαα’αα»ααα·ααααα»αααΆααα·αα
α»ααααααααα
αα α’αααααααΊααΆαGuot Flaresαααα½α
ααααΆααα·α
ααΆα α’ αααααα»ααα½αααααΆαα¬ ααααΆαTophi
ααΆαααααΆααΆαααααΊGuot αααα½α
ααααΆαα
-ααΆαααααΎααααΆαColchicine NSAIDs α¬ glucocorticoids ααΊααΆααΆαααααΆααΆααααααααααααααΌααααα’ααααΆααΆα IL-1 α¬ ACTH inhibitors
- ααααα·αααΎ cochicine ααααΌαααΆαααααΎαααΎαααααΆααααΆαααααΆααΆαααΌααααα·αααΆααααααΎαααΆααααΎαααα·αααααααααααΆαααααααα·αααααΆαααΌα
ααααΆ α αΎαααΆααααααααααααααΆαα Side affect
- ααααΎααααΆαααΆαααααΆααααΊααΈαααα
ααΆααΆαααααΆααΆααααααα ααα’ααΆααΆααα·αααααΎα’αΈααα ααΎααΆαααααααΆα
- ααααα·αααΎα’αααααααΊGuot αααα½α
ααααΆααα·αααααΆα colchicine, NSAIDs α¬ glucocorticoids αα·αααΆαααααα·αααααΆα α¬αα·αααααΌαααΆαααααΎααααΆαα αααααΆαααααΎααααΆα IL-1 inhibitors ααΊααΆααΆαααααΆααααααΆαααααααααα
- ααΆαααααΎααααΆααααααΆα glucocorticoids α
αΆαα ααα’ααΆαααααΆα IL-1 α¬ ACTH inhibitors
α
ααααα’αααααααΊααααα·αα’αΆα
ααααΎααααΆααααααΆαα
ααΆααααααααααααααααααα
α Management of lifestyle factors
- ααααα αααα·αααΆαα·αααααΉα α’αΆα αΆααααααΆαααΆαα· purine
highβfructose corn syrup
- ααααααααααααααα Using a weight loss program (no specific program endorsed)
- αα·αααααααααΈααΆααΈααα α
ααααα’αααααααΊαααΆααααααΆααGuot ααΎααααααααααΈαα·ααααα½αα
ααα½αα
ααΆααααααααααααααΆααααα»αααααΎααΆαααα
αΆαα
- αααα½α hydrochlorothiazide αααααααΎααααΆααααααΆαααΆαααααα·αααΎα’αΆα
ααααΎαα
ααΆα
- ααααΎαααΎαααααΆα Losartan ααΆααααΆαααααΆααΆαααααΊααΎαααΆαααΆααααΎαααΈ α‘ ααΎααααΆαααΆαα αΆαααΆαα
- αααααααΎ Stopping lowβdose aspirin (α
ααααα’αααααααΊααααααα»αααααΎααααΆαααααααααΆααααααΊαααααααα) αα·αααααΌαααΆαααααΆαα’ααααααΎα
ααααα’αααααααΊαααααΆαααααΊαααΆααααααΆααGuot ααΎααααααααααΈαα·ααααα½αα
ααα½αα
- αα·αααααααααααΎααααΆααααα
α»αααααΆαα fenofibrat α
ααααα’αααααααΊαααααΆαααααΊαααΆααααααΆααGuot
Adding or switching cholesterolβlowering agents to fenofibrate is conditionally recommended against for patients with gout, regardless of disease activity.
αα»ααααΆ24-07-20