Gout management
What the major U.S. guidelines recommend, with a link to verify each at the source. A quick-reference summary for clinicians, not medical advice.
ACR · 2020
Treat-to-target: serum urate goal <6 mg/dL (strong). Allopurinol is preferred first-line ULT for all, including CKD stage 3 or worse; start <=100 mg/day (lower in CKD) and titrate. Strongly start ULT for >=1 subcutaneous tophus, gout-attributable radiographic damage, or >=2 flares/year.
Verify at ACR →ACR · 2020
Conditionally start ULT for prior flare with <2 flares/year, or a first flare plus CKD stage 3 or worse, serum urate >9 mg/dL, or urolithiasis. Conditionally recommend against ULT in asymptomatic hyperuricemia. When starting ULT, give anti-inflammatory flare prophylaxis for 3 to 6 months.
Verify at ACR →