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Something Old, Something New: the ACR Gout Treatment Guideline and Its Evolution from 2012 to 2020

  • Crystal Arthritis (M Pillinger & M Toprover, Section Editors)
  • Published:
Current Rheumatology Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

Gout is the most common inflammatory arthritis in the USA, affecting about 4% of all adults. The American College of Rheumatology (ACR) released a new guideline in 2020 to help with the management of gout. This guideline serves as an update to the previous set of guidelines which the ACR published in 2012. The purpose of this review is to compare the 2012 ACR gout guidelines to the newly released 2020 ACR gout guidelines.

Recent Findings

There are many similarities between the two guidelines, and also several key differences. The 2020 guidelines assist in the clinical management of gout by healthcare providers. Additionally, the new guidelines utilize newer literature to help create an evidence-based approach to the treatment for gout. We discuss the methodological approach to each guideline (RAND versus GRADE), as well as the final recommendations for gout flare treatment, use of imaging, urate-lowering therapy, lifestyle changes, and genetic testing prior to initiation of allopurinol in each guideline, as well as lingering issues that the 2020 guidelines have not addressed.

Summary

We dissect both the 2012 and 2020 ACR gout guidelines to summarize the key similarities and differences between the two as well as discuss how the authors came to the recommendations that they did for each set of guidelines.

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Data Availability

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Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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Author information

Authors and Affiliations

  1. Division of Rheumatology, NYU Grossman School of Medicine, New York, NY, USA

    Rebecca E. Cohen, Michael H. Pillinger & Michael Toprover

  2. Rheumatology Section, New York Harbor Health Care System, New York Campus, United States Department of Veterans Affairs, New York, NY, USA

    Michael H. Pillinger & Michael Toprover

  3. Division of Rheumatology, NYU Langone Health, 301 East 17th Street, New York, NY, 10003, USA

    Michael Toprover

Authors
  1. Rebecca E. Cohen
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  2. Michael H. Pillinger
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  3. Michael Toprover
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Contributions

All authors made substantial and equal contributions to the conception, research, and drafting of this manuscript; approve the submitted version; and agree to be accountable for all aspects of the work.

Corresponding author

Correspondence to Michael Toprover.

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Conflict of Interest

RC—nothing to disclose; MT—nothing to disclose; MHP—investigator-initiated research grants from Horizon Therapeutics and Hikma Pharmaceuticals; consultancies with Swedish Orphan Biovitrum and Horizon Therapeutics. MHP is supported in part by NIH grant 1UL1 TR001445 from the National Center for Advancing Translational Sciences.

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This work is original and has not been published elsewhere in any form, nor submitted to any other journal. As a review article, no additional ethics approvals are required.

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Cohen, R.E., Pillinger, M.H. & Toprover, M. Something Old, Something New: the ACR Gout Treatment Guideline and Its Evolution from 2012 to 2020. Curr Rheumatol Rep 23, 4 (2021). https://doi.org/10.1007/s11926-020-00967-8

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  • DOI: https://doi.org/10.1007/s11926-020-00967-8

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