The European League Against Rheumatism (EULAR) have updated their recommendations on the management of gout to reflect novel treatments and evidence surrounding already established treatments.

A EULAR task force, consisting of 24 experts, reviewed the literature concerning all aspects of gout treatment. The resulting recommendations were reached via use of the Delphi consensus approach.

Among their findings, the researchers recommend an interleukin-1 blocker to be considered for patients with regular flares who have contraindications to colchicine, NSAIDs and corticosteroids. 

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Urate-lowering therapy (ULT) should be considered from the first presentation of the disease, in tandem with an educational and non-pharmacological management approach. Allopurinol is recommended as first-line ULT with dosing adjusted according to renal function. Should allopurinol not suffice in reaching the desired serum uric acid level, then febuxostat, a uricosuric or combining a xanthine oxidase inhibitor with a uricosuric, should be considered.

Pegloticase is recommended for patients with refractory gout.

The new recommendations represent an update to the EULAR’s last recommendations in 2006.

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