BACKGROUND: New drugs and new evidence concerning the use of established treatments have become available since the publication of the first European League Against Rheumatism (EULAR) recommendations for the management of gout, in 2006. This situation has prompted a systematic review and update of the 2006 recommendations. METHODS: The EULAR task force consisted of 15 rheumatologists, 1 radiologist, 2 general practitioners, 1 research fellow, 2 patients and 3 experts in epidemiology/methodology from 12 European countries. A systematic review of the literature concerning all aspects of gout treatments was performed. Subsequently, recommendations were formulated by use of a Delphi consensus approach. RESULTS: Three overarching principles and 11 key recommendations were generated. For the treatment of flare, colchicine, non-steroidal anti-inflammatory drugs (NSAIDs), oral or intra-articular steroids or a combination are recommended. In patients with frequent flare and contraindications to colchicine, NSAIDs and corticosteroids, an interleukin-1 blocker should be considered. In addition to education and a non-pharmacological management approach, urate-lowering therapy (ULT) should be considered from the first presentation of the disease, and serum uric acid (SUA) levels should be maintained at<6 mg/dL (360 µmol/L) and <5 mg/dL (300 µmol/L) in those with severe gout. Allopurinol is recommended as first-line ULT and its dosage should be adjusted according to renal function. If the SUA target cannot be achieved with allopurinol, then febuxostat, a uricosuric or combining a xanthine oxidase inhibitor with a uricosuric should be considered. For patients with refractory gout, pegloticase is recommended. CONCLUSIONS: These recommendations aim to inform physicians and patients about the non-pharmacological and pharmacological treatments for gout and to provide the best strategies to achieve the predefined urate target to cure the disease.

Academic Rheumatology University of Nottingham Nottingham UK

AP HP Dèpartement d'Epidèmiologie et Recherche Clinique Hôpital Bichat Paris France APHP Centre de Pharmacoèpidèmiologie Paris France Univ Paris Diderot Paris France INSERM UMR 1123 ECEVE Paris France

AP HP hôpital Lariboisière service de Rhumatologie F 75010 Paris France; Inserm UMR1132 Hôpital Lariboisière F 75010 Paris France; Universitè Paris Diderot Sorbonne Paris Citè F 75205 Paris France

Arthritis Research UK Primary Care Centre University of Keele Keele UK

Department of Diagnostic and Interventional Radiology Lausanne University Hospital Lausanne Switzerland

Department of Primary and Community Care Radboud University Medical Centre Nijmegen Netherlands

Department of Rheumatology Diakonhjemmet Hospital Oslo Norway

Department of Rheumatology Hospital General Universitario de Alicante Alicante Spain

Department of Rheumatology University Clinic at the Technical University Dresden Germany

Department of Rheumatology VieCuri Medical Centre Venlo and Scientific IQ HealthCare Radboud UMC Nijmegen The Netherlands

Institute of Rheumatology Prague and Department of Rheumatology 1st Faculty of Medicine Charles University Prague Czech Republic

Institute of Rheumatology RAMS Moscow Russia

Osteoarticular Research Group University of Edinburgh Edinburgh UK

Patient from Nottingham UK Paris

Rheumatology Unit Clínica Coração de Jesus Lisbon Portugal

Rheumatology Unit University of Padova Padova Italy

Seccion de Rheumatologia Hospital de Cruces Baracaldo Spain

Service de Rhumatologie CHUV and Universitè de Lausanne Lausanne Switzerland

Ann Rheum Dis. 2017 Jan;76(1):e1. doi: 10.1136/annrheumdis-2016-210352. PubMed

Nat Rev Rheumatol. 2016 Nov;12(11):628-630. doi: 10.1038/nrrheum.2016.150. PubMed

Ann Rheum Dis. 2017 Jan;76(1):e2. doi: 10.1136/annrheumdis-2016-210356. PubMed

Ann Rheum Dis. 2018 Apr;77(4):e20. doi: 10.1136/annrheumdis-2017-211418. PubMed

Ann Rheum Dis. 2018 Apr;77(4):e21. doi: 10.1136/annrheumdis-2017-211423. PubMed

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