ACR 2012 Gout Guidelines Summary graphic

ACR Gout Management Principles

I reviewed ACR Gout Management Principles for all gout sufferers. It tells you which principles of gout management are important to you, depending on which type of gout sufferer you are.

I introduced GoutPal Hout Sufferer Types in Questions for Gout Sufferers.

If you do not know which Gout Sufferer type you are, you should read that introduction first.

ACR Gout Management Guidelines

American College of Rheumatology (ACR) produced their gout management guidelines in 2012. Specific knowledge about gout and treatment choices have grown since then. But, the principles are sound, and every gout sufferer needs to know them.

Even if you have rejected mainstream medical treatments, you still need to adopt most of the principles. Lifestyle changes and herbalism still need to be managed correctly.

Let’s start with the most important principle…

Gout Management Must Be Personal.

From the guidelines introduction:

the ultimate determination regarding [American College of Rheumatology Guidelines for Management of Gout] to be made by the physician in light of each patient’s individual circumstances.

And, in the body of the guidelines, there are four more personal recommendations. These recommend doctors set personal uric acid level targets for each gout patient. Then, they should treat patients individually according to that target. E.g.:

treat to the serum urate target appropriate for the individual patient

There are several more recommendations that emphasize the individual nature of effective gout management.

These guidelines cannot substitute for individualized direct assessment of the patient, coupled with clinical decision making by a competent health care practitioner.

Gout Patients Need Education

Rheumatologists advise doctors that gout patient education is vital to promote adherence to treatment plans:

Patient education on diet, lifestyle, treatment objectives, and management of comorbidities is a recommended core therapeutic measure in gout.

I’ve taken this to heart with my seven websites dedicated to educating gout sufferers. Tell me what you need to know.

Investigate Causes and Symptoms Of Gout

Doctors should investigate certain common causes of gout to gain a better personal profile. This is especially significant where gout patients are medicated for other diseases. Or if the patient is less than 25 years of age.

Doctors should evaluate the severity of gout.

clinicians can work with patients to record and estimate the number per year and severity of acute attacks of gouty arthritis per year.

Encourage Healthy Lifestyle

There are broad recommendations such as “Healthy overall diet”. There are specifics recommendations, including labels on certain foods and lifestyle factors: Avoid, Limit, or Encourage.

Overall, the guidelines are too general. But, I can give you personal gout diet guidance in the gout forum.

Reduce Uric Acid Below 6mg/dL

This part of the guidelines is least clear. But, it has been clarified subsequently by the ACR (unfortunately, I’ve lost the link to the interview, so tell me if you know it). The guidelines mention a minimum target of less than 6mg/dL. I.e. the minimum reduction is to get patients below 6. Most gout patients will need to target less than 5mg/dL.

The maximum uric acid level is below 6, and most gout sufferers should reduce below 5mg/dL.

Gout Pain Control Additional To Uric Acid Control

The ACR guidelines recognize that pain control is usually required alongside uric acid control. Use preventative pain control for at least 6 months from the start of uric acid lowering treatment. This should continue after target uric acid level is reached. Normally, this is for 3 months after achieving target uric acid level. If visible tophi are present, then continue pain control for 6 months after reaching uric acid target.

Never stop uric acid lowering if a gout flare occurs.

If pain control is started without uric acid control, consider starting uric acid lowering after pain has subsided. Later research indicates that it is beneficial to start uric acid lowering immediately.

Gout Management Guidelines Review

I introduced ACR Gout Management Guidelines in Taking Gout Guidelines To Task? I will continue to promote and explain the ACR guidelines. I will continue to provide better guidelines that help you manage your gout.

To do that, I need your help. Help me review and improve my gout guidelines. Tell me how I can improve these gout management principles.

ACR 2012 Gout Guidelines Summary graphic
The management summary every gout sufferer should know.

Your Gout Management Principles

Now, you can see which gout management principles are most important to you.

Or, can you?

I’m on a quest to improve all my guidelines. I want you to:

  1. Understand which gout guidelines are important to you.
  2. See which personal choices you should discuss with your health adviser.
  3. Tell me if you don’t understand your choices.
  4. Get personal help to make the right choices for you.

Can you see which gout management principles are important to you?
Do you understand how to apply those principles to your gout management plans?

Discuss your gout management principles in the gout forum now.

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Keith Taylor at GoutPal

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