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ACP Gout Guideline

December 27, 2016

Short Attention Span Summary

Doc, I got the gouch!
Have you ever had a patient conflate the words gout and ouch?  It’s fitting.  This is an excellent synopsis of acute gout treatment from the ACP.  The bullet points are already summarized below in the abstract for easy consumption.  Two points I want to emphasize: starting urate lowering therapy is not something we need to do in the ED, and colchicine is good.  Although colchicine has become prohibitively expensive thanks to Big Pharma.

Spoon Feed
This is an excellent summary of acute gout therapy.


Ann Intern Med. 2016 Nov 1. doi: 10.7326/M16-0570. [Epub ahead of print]

Management of Acute and Recurrent Gout: A Clinical Practice Guideline From the American College of Physicians.

Qaseem A1, Harris RP1, Forciea MA1; Clinical Guidelines Committee of the American College of Physicians.

Author information:

1From the American College of Physicians and University of Pennsylvania Health System, Philadelphia, Pennsylvania, and University of North Carolina School of Medicine, Chapel Hill, North Carolina.



The American College of Physicians (ACP) developed this guideline to present the evidence and provide clinical recommendations on the management of gout.


Using the ACP grading system, the committee based these recommendations on a systematic review of randomized, controlled trials; systematic reviews; and large observational studies published between January 2010 and March 2016. Clinical outcomes evaluated included pain, joint swelling and tenderness, activities of daily living, patient global assessment, recurrence, intermediate outcomes of serum urate levels, and harms.

Target Audience and Patient Population:

The target audience for this guideline includes all clinicians, and the target patient population includes adults with acute or recurrent gout.

Recommendation 1:

ACP recommends that clinicians choose corticosteroids, nonsteroidal anti-inflammatory drugs (NSAIDs), or colchicine to treat patients with acute gout. (Grade: strong recommendation, high-quality evidence).

Recommendation 2:

ACP recommends that clinicians use low-dose colchicine when using colchicine to treat acute gout. (Grade: strong recommendation, moderate-quality evidence).

Recommendation 3:

ACP recommends against initiating long-term urate-lowering therapy in most patients after a first gout attack or in patients with infrequent attacks. (Grade: strong recommendation, moderate-quality evidence).

Recommendation 4:

ACP recommends that clinicians discuss benefits, harms, costs, and individual preferences with patients before initiating urate-lowering therapy, including concomitant prophylaxis, in patients with recurrent gout attacks. (Grade: strong recommendation, moderate-quality evidence).

PMID: 27802508 [PubMed – as supplied by publisher]

What are your thoughts?