The American College of Rheumatology (ACR) has issued new guidelines for the management of gout, a form of arthritis. Published in the October 2012 issue of Arthritis Care & Research, the guidelines recommend a target serum urate (uric acid) level of below 6 mg/dL for people diagnosed with gout, achieved through, if possible, changes in lifestyle and diet or with use of approved drug therapies.
The new guidelines reflect a growing awareness of the increased prevalence of gout, which has risen to almost 4% of the U.S. adult population. It is believed that this increase is associated with the rise in underlying conditions that contribute to hyperuricemia (high uric acid levels in the blood) such as hypertension, obesity, metabolic syndrome, type 2 diabetes, and chronic kidney disease.
Gout occurs when uric acid, a normal waste product from the breakdown of purines (compounds formed from the natural turnover of cells and to a lesser extent from the digestion of certain food), builds up in the bloodstream or cannot be eliminated fast enough by the kidneys. The excess uric acid then forms needle-like crystals that are deposited in the fluid and tissues of one or more joints, causing inflammation, swelling, and severe pain. The most frequently affected joint is the big toe, but gout can also occur in the hands, wrists, knees, and feet. Attacks of gout may occur several times a year and last for several days.
The ACR guidelines aimed to improve the management of gout as well as patient education about this condition, especially the role of excess uric acid, and the complicating effect of underlying conditions. To this end, the guidelines emphasize the importance of dietary and lifestyle changes that can help to manage gout, including a reduced consumption of alcohol and of purine-rich foods. Recommendations include avoiding liver and kidney and foods and drinks sweetened with high fructose corn syrup as well as eating less beef, lamb, pork, and seafood like sardines and shellfish that have high purine content. Low-fat dairy products and vegetables are encouraged.
However, if dietary changes are inadequate in improving signs and symptoms and lowering serum urate to a target level of less than 6 mg/dL, drug therapy may be needed. The guidelines offer further recommendations on treatment for gout, including first-line therapy, dosages, and combination therapies. It is hoped that these guidelines will increase awareness of the need for urate control and for the management of underlying conditions as well as of the list of available therapeutic options, which continues to grow.
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American College of Rheumatology. 2012 American College of Rheumatology Guidelines for Management of Gout. Available online at http://www.rheumatology.org/practice/clinical/guidelines/gout.asp through http://www.rheumatology.org. Accessed November 2012.
Walsh, N. ACR Puts Out Gout Guidelines. MedPage Today. Available online at http://www.medpagetoday.com/Rheumatology/GeneralRheumatology/35033 through http://www.medpagetoday.com. Accessed November 2012.