For the first time ever, the American College of Rheumatology, or ACR, has issued guidelines for the management of gout. They include not only pharmacological approaches, but also lifestyle and dietary changes that could affect the course of the disease.  

Gout, a type of arthritis, occurs when uric acid in the bloodstream builds up too quickly or can’t be eliminated fast enough and is, instead, deposited as needle-shaped crystals in the tissues of the body, including joints, causing intense pain. Uric acid is a waste product created when the body metabolizes purines, a substance found in some foods and drinks. Some patients experience only one gout attack (an acute flare) while others have recurrent attacks.

The guidelines, published in the October 2012 issue of Arthritis Care & Research, were put together using input from national and international medical experts. An eleven-member task force, which included seven rheumatologists, voted on the recommendations.

Robert Terkeltaub, MD, chief of rheumatology at the VA Medical Center in San Diego and a professor of medicine at the University of California, San Diego, calls the recommendations “historic.” Dr. Terkeltaub, who led the design of the case scenarios used to help develop the recommendations, says that the time was right to set down guidelines.

“Gout affects about 3.9 percent of U.S. adults. There’s been a marked increase in gout visits [to doctors] over the last few decades. There are [also] new drugs out to treat gout,” Dr. Terkeltaub says. “We wanted to come out with something with a rating of new agents approved by the [Food and Drug Administration], and also take a look at all the clinical research out there in the last 15 to 20 years.”

The guidelines were created using a method that allowed for expert consensus – even when there was insufficient published literature – to guide clinical decision-making. Dr. Terkeltaub says that indicates more research into gout management is needed.