Table I.

ACR (2012, 2020), 3E Initiative (2014) and EULAR (2016) recommendations for management of hyperuricemia in patients with acute and chronic gout – similarities [25–28]

Start acute gout treatment in the first 24 hours

Use colchicine p.o. or NSAIDs p.o., or GCS p.o. i.a. as first-line agents in acute gout

Start ULT only after resolution of acute gout phase; however, if ULT was started before acute gout episode, do not discontinue

Use long-term ULT only in selected cases, i.a. in case of tophi/ chronic gouty arthropathy

Use allopurinol, febuxostat and probenecid as first-line agents and pegloticase as a second-line drug

Start allopurinol at a low dose and gradually escalate to a minimal effective dose

Monitor UA levels during ULT

Treat to target (until all symptoms’ resolution and UA target level are achieved)

Maintain UA target level lifelong

Consider secondary gout prophylaxis with colchicine or NSAIDs

Screen patients with gout for common comorbidities associated with hyperuricemia

3E – Evidence, Expertise, Exchange, ACR – American College of Rheumatology, EULAR – European League Against Rheumatism, GCS – glucocorticosteroids, NSAID – nonsteroidal anti-inflammatory drug, UA – uric acid, ULT – urate-lowering therapy.