Some of the task force’s key recommendations for gout management include:

  • Increased intake of vegetables
  • Decreased intake of purine-rich meat and seafood, but no vote on avoiding purine-rich vegetables, such as beans
  • Reduced alcohol consumption, especially beer, and no alcohol during an acute gout attack
  • Consideration of allopurinol, or Zyloprim, and febuxostat, or Uloric, as first-line pharmacological agents to lower uric acid levels;
  • Using screening tests to determine allopurinol hypersensitivity before initiating therapy in susceptible patients;
  • Dosing allopurinol initially at no more than 100 mg/day – and less than that in those with moderate to severe chronic kidney disease, with gradual increases in dose to at least 300 mg/day in both groups;
  • Establishing target serum uric acid levels of less than 6 milligrams per deciliter (mg/dL);
  • Using combination therapies if allopurinol or febuxostat do not sufficiently lower uric acid levels;
  • Use of pegloticase, or Krystexxa, if other therapies fail and gout is severe.

Dr. Terkeltaub says gout is on the rise for several reasons – among them, the growing number of people who are living longer and, in the process, developing other diseases that raise the risk for gout, including diabetes and kidney disease. Sometimes, the drugs used to treat other diseases can increase uric acid levels, such as certain diuretics used in treating high blood pressure.

Dietary issues, including obesity, are also contributing to the increase in gout. Getting down to an ideal body weight is another of the “lifestyle” recommendations, says Dr. Terkeltaub. Others include smoking cessation and drinking enough fluids. “One of the triggers for an acute gout attack is dehydration,” he says. “So the recommendation is 6- to 8-[ounce] servings of water per day.”

But Dr. Terkeltaub warns that though lifestyle changes are beneficial, they alone may not do enough to lower serum uric acid to a safe level. “The problem is the expectation of gout from the patient’s view. They think it’s simple to manage with diet, fitness and avoiding alcohol. But lifestyle modifications only lower uric acid levels by around 15 percent.”

Daniel H. Solomon, MD, a professor of medicine at Harvard Medical School in Boston, calls lifestyle and dietary changes “very important” in gout management. He co-authored an editorial, which appears in the same issue as the guidelines, that reviews the role of diet in gout.

“They may not yield immediate results,” Dr. Solomon says. “However, lifestyle changes and diet can yield clinically significant reductions in uric acid in some people.”

But Dr. Solomon says most patients with high serum uric acid levels who have gout or kidney stones will require some form of drug treatment.

A second set of recommendations, published in the same issue, addresses the topic of treating an acute attack of gout. Some of the key points include:

  • Treat with medication within 24 hours of the start of an attack;
  • First-line options include nonsteroidal anti-inflammatory drugs, or NSAIDs, colchicine, or Colcrys, and oral corticosteroids, either alone or, in some cases, in combination;
  • Use of urate-lowering drugs throughout the attack period;
  • Use of anti-inflammatory therapy after the acute attack if there is any evidence of disease activity and/or if serum uric acid has not reached target levels.

Dr. Terkeltaub says the new recommendations do more than just serve as a guide for patients and clinicians. “It brings gout into the limelight more, and that’s something important.”