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In response to a request for proposal from the American College of Rheumatology (ACR), our group was charged with developing nonpharmacologic and pharmacologic guidelines for treatments in gout that are safe and effective, i.e., with an acceptable risk/benefit ratio. These guidelines for the management and antiinflammatory prophylaxis of acute attacks of gouty arthritis complement our article on guidelines to treat hyperuricemia in patients with evidence of gout (or gouty arthritis).

Gout is the most common cause of inflammatory arthritis in adults in the US. Clinical manifestations in joints and bursa are superimposed on local tissue deposition of monosodium urate crystals. Acute gout characteristically presents as a self-limited attack of synovitis (also called “gout flare”). Acute gout attacks account for a major component of the reported decreased health-related quality of life in patients with gout . Acute gout attacks can be debilitating and are associated with decreased work productivity.

Urate-lowering therapy (ULT) is a cornerstone in the management of gout and, when effective in lowering serum urate, is associated with a decreased risk of acute gouty attacks. However, during the initial phase of ULT, there is an early increase in acute gout attacks, which has been hypothesized due to remodeling of articular urate crystal deposits as a result of rapid and substantial lowering of ambient urate concentrations . Acute gout attacks attributable to the initiation of ULT may contribute to nonadherence in long-term gout treatment, as reported in recent studies.