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Evidence Summary

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In people with acute gout, steroids, nonsteroidal anti-inflammatory drugs, or low-dose colchicine is recommended, but lifestyle changes are not supported

Qaseem A, Harris RP, Forciea MA Management of Acute and Recurrent Gout: A Clinical Practice Guideline From the American College of Physicians. Ann Intern Med. 2017;166:58-68.

Review and guideline questions

In adults who have acute gout, what are the effects of non-drug (e.g., lifestyle interventions, dietary supplements, or alternative treatments) and drug treatments?

In people who have high levels of uric acid (hyperuricemia), do treatments to lower uric acid prevent gout attacks, and is monitoring of uric acid levels helpful?

In people who have ongoing (chronic) gout, what are the effects of stopping drug treatments?

What are the recommendations from the U.S. Preventive Task Force for acute and chronic gout?

Background

Gout is a painful condition that causes redness, swelling, and tenderness in joints. Gout happens when urate crystals build up in joints. These crystals form when a person has high levels of uric acid in their blood.

How the review was done

The researchers did a systematic review, searching for studies up until March 2016.

They found 22 randomized controlled trials of non-drug treatments and 28 randomized controlled trials of drug treatments for acute gout. They found 35 reports on treatments to lower uric acid levels and 18 on monitoring uric acid levels. They found 3 studies about stopping drug treatments in people who had chronic gout.

What the researchers found

There was not enough evidence to make any recommendations on non-drug treatments such as lifestyle interventions, diet, or traditional Chinese medicine.

Steroids, nonsteroidal anti-inflammatory drugs, and colchicine reduced pain.

Low dose and high dose colchicine reduced pain by about the same amount, but there were fewer stomach problems with lower doses.

In people with high uric acid levels, short-term treatment aimed at lowering levels reduces the number of gout flares, but long-term use after a first gout attack or in people with infrequent gout attacks is not recommended.

There was not enough evidence to make any recommendations for monitoring uric acid levels.

Conclusion

In people with acute gout, treatment with steroids, nonsteroidal anti-inflammatory drugs, or low-dose colchicine is recommended, but lifestyle changes are not supported.

U.S. Preventive Task force recommendations for people with acute gout

Condition

Recommendations and evidence

Quality rating

Acute gout

No recommendations were made about non-drug treatments since there was not enough evidence

Insufficient

Acute gout

Corticosteroids, NSAIDs, and colchicine reduce pain in patients with acute gout and should be chosen as therapy

High

Acute gout

Lower and higher doses of colchicine reduce pain by about the same amount, but lower doses are linked to fewer stomach side effects

Moderate

High uric acid

Do not start long-term treatment with drugs that lower uric acid after a first attack of gout in most patients or in patients with infrequent attacks (less than 2 attacks per year)

Moderate

High uric acid

No recommendations were made about monitoring uric acid levels

Insufficient

 




Glossary

Randomized controlled trials
Studies where people are assigned to one of the treatments purely by chance.
Systematic review
A comprehensive evaluation of the available research evidence on a particular topic.

Related Web Resources

DISCLAIMER These summaries are provided for informational purposes only. They are not a substitute for advice from your own health care professional. The summaries may be reproduced for not-for-profit educational purposes only. Any other uses must be approved by the McMaster Optimal Aging Portal (info@mcmasteroptimalaging.org).

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