To Treat or Not to Treat (to Target) in Gout
Authors: Tuhina Neogi, Ted R. Mikuls
Journal: Annals of Internal Medicine (2016)

Editorials3 January 2017To Treat or Not to Treat (to Target) in GoutTuhina Neogi, MD, PhD and Ted R. Mikuls, MD, MSPHTuhina Neogi, MD, PhDFrom Boston University School of Medicine, Boston, Massachusetts; University of Nebraska Medical Center, Omaha, Nebraska. and Ted R. Mikuls, MD, MSPHFrom Boston University School of Medicine, Boston, Massachusetts; University of Nebraska Medical Center, Omaha, Nebraska.Author, Article, and Disclosure Informationhttps://doi.org/10.7326/M16-2401 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Gout, the most common form of inflammatory arthritis, has a well-understood pathophysiology and effective treatments are available. Yet, gout is poorly managed, with approximately 70% of patients having recurrent flares (1). Elevation of serum urate levels to above 404 µmol/L (6.8 mg/dL) under normal physiologic conditions can lead to monosodium urate crystallization. Hyperuricemia is not a mere "comorbid risk factor" (2) of gout but rather the main pathophysiologic culprit that causes flares, tophi, and joint damage; therefore, management of hyperuricemia is a key tenet of disease control.It is in this context that we review the American College of Physicians ...References1. Neogi T, Hunter DJ, Chaisson CE, Allensworth-Davies D, Zhang Y. Frequency and predictors of inappropriate management of recurrent gout attacks in a longitudinal study. J Rheumatol. 2006;33:104-9. [PMID: 16267879] MedlineGoogle Scholar2. Qaseem A, McLean RM, Starkey M, Forciea MA; Clinical Guidelines Committee of the American College of Physicians. Diagnosis of acute gout: a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2017;166:52-7. doi:10.7326/M16-0569 LinkGoogle Scholar3. Qaseem A, Harris RP, Forciea MA; Clinical Guidelines Committee of the American College of Physicians. Management of acute and recurrent gout: a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2017;166:58-68. doi:10.7326/M16-0570 LinkGoogle Scholar4. Shekelle PG, Newberry SJ, FitzGerald JD, Motala A, O'Hanlon CE, Tariq A, et al. Management of gout: a systematic review in support of an American College of Physicians clinical practice guideline. Ann Intern Med. 2017;166:37-51. doi:10.7326/M16-0461 LinkGoogle Scholar5. Newberry SJ, FitzGerald JD, Motala A, Booth M, Maglione MA, Han D, et al. Diagnosis of gout: a systematic review in support of an American College of Physicians clinical practice guideline. Ann Intern Med. 2017;166:27-36. doi:10.7326/M16-0462 LinkGoogle Scholar6. Khanna D, Fitzgerald JD, Khanna PP, Bae S, Singh MK, Neogi T, et al; American College of Rheumatology. 2012 American College of Rheumatology guidelines for management of gout. Part 1: systematic nonpharmacologic and pharmacologic therapeutic approaches to hyperuricemia. 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Stamp LK, Taylor WJ, Jones PB, Dockerty JL, Drake J, Frampton C, et al. Starting dose is a risk factor for allopurinol hypersensitivity syndrome: a proposed safe starting dose of allopurinol. Arthritis Rheum. 2012;64:2529-36. [PMID: 22488501] doi:10.1002/art.34488 CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From Boston University School of Medicine, Boston, Massachusetts; University of Nebraska Medical Center, Omaha, Nebraska.Grant Support: By grants P60 AR47785 (Dr. Neogi) and P50 AR060772 (Dr. Mikuls) from the National Institutes of Health.Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M16-2401.Corresponding Author: Tuhina Neogi, MD, PhD, Clinical Epidemiology Unit and Rheumatology, Boston University School of Medicine, 650 Albany Street, Suite X200, Boston, MA 02118.Current Author Addresses: Dr. Neogi: Clinical Epidemiology Unit and Rheumatology, Boston University School of Medicine, 650 Albany Street, Suite X200, Boston, MA 02118.Dr. Mikuls: Department of Internal Medicine and Division of Rheumatology, University of Nebraska Medical Center, 986270 Nebraska Medical Center, Omaha, NE 68198-6270.This article was published at www.annals.org on 1 November 2016. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoThe Long and Winding Road to Clinical Guidelines on the Diagnosis and Management of Gout Robert M. McLean Diagnosis of Gout: A Systematic Review in Support of an American College of Physicians Clinical Practice Guideline Sydne J. Newberry , John D. FitzGerald , Aneesa Motala , Marika Booth , Margaret A. Maglione , Dan Han , Abdul Tariq , Claire E. O'Hanlon , Roberta Shanman , Whitney Dudley , and Paul G. Shekelle Diagnosis of Acute Gout: A Clinical Practice Guideline From the American College of Physicians Amir Qaseem , Robert M. McLean , Melissa Starkey , Mary Ann Forciea , and Management of Gout: A Systematic Review in Support of an American College of Physicians Clinical Practice Guideline Paul G. Shekelle , Sydne J. Newberry , John D. FitzGerald , Aneesa Motala , Claire E. O'Hanlon , Abdul Tariq , Adeyemi Okunogbe , Dan Han , and Roberta Shanman Management of Acute and Recurrent Gout: A Clinical Practice Guideline From the American College of Physicians Amir Qaseem , Russell P. Harris , Mary Ann Forciea , and Metrics Cited bySerum growth differentiation factor-15 and non-esterified fatty acid levels in patients with coronary artery disease and hyperuricemiaWhen underlying biology threatens the randomization principle — initial gout flares of urate-lowering therapyPrevalence, Incidence, and Years Lived With Disability Due to Gout and Its Attributable Risk Factors for 195 Countries and Territories 1990–2017: A Systematic Analysis of the Global Burden of Disease Study 2017Understanding the patient voice in gout: a quantitative study conducted in EuropeAsymptomatic hyperuricaemia: a silent activator of the innate immune systemGoutFailure to reach uric acid target of <0.36 mmol/L in hyperuricaemia of gout is associated with elevated total and cardiovascular mortalityEvaluation of Proposed Criteria for Remission and Evidence‐Based Development of Criteria for Complete Response in Patients With Chronic Refractory GoutMoving the Needle: Improving the Care of the Gout PatientUltrasound evaluation in follow-up of urate-lowering therapy in gout: the USEFUL studyThe Evolving Art and Science of American College of Rheumatology GuidelinesTreatment GuidelinesPatient education and engagement in treat-to-target gout careDevelopment of the American College of Rheumatology Electronic Clinical Quality Measures for GoutDiscordant American College of Physicians and international rheumatology guidelines for gout management: consensus statement of the Gout, Hyperuricemia and Crystal-Associated Disease Network (G-CAN)My Treatment Approach to GoutGout 3 January 2017Volume 166, Issue 1Page: 71-72KeywordsAllopurinolBloodClinical epidemiologyDisclosureGoutRandomized trialsRheumatologySystematic reviewsTreatment guidelinesUric acid ePublished: 1 November 2016 Issue Published: 3 January 2017 Copyright & PermissionsCopyright © 2016 by American College of Physicians. 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