New gout guidelines court controversy

New guidelines from the American College of Physicians advise doctors not to treat gout to target, in stark contrast to both EULAR and ACR recommendations.

Published this week in the Annals of Internal Medicine, the guidelines recommend corticosteroids, NSAIDs or low-dose colchicine for the treatment of acute gout.

Corticosteroids should be tried first in patients without contraindications, the authors suggest, as they are as effective as NSAIDs but have fewer side effects.

The authors found little evidence of the impact of dietary changes on outcomes or for reducing serum urate levels in patients.

But the real bombshell in the guidelines is the recommendation against initiating long-term urate-lowering therapy after a first gout flare or in patients with infrequent flares.

This challenges recent guidelines from the American College