ACP 2017 gout guideline: key recommendations

Official guidelineManagement of Acute and Recurrent Gout: A Clinical Practice Guideline From the American College of Physicians. ACP, 2017.
Read the official guideline · Checked for a newer edition on 2026-10-20
We do not reproduce the guideline text — this page is an independent summary.

Who it applies to

Adults with acute gout flares or recurrent gout managed in outpatient or primary care settings.

Key recommendations

Clinicians should choose among corticosteroids, NSAIDs, or colchicine to treat patients with acute gout, based on patient preference, comorbidities, and drug interactions.
strong, high-quality evidence
Low-dose colchicine is recommended over high-dose colchicine when colchicine is chosen, as it has similar efficacy with fewer gastrointestinal side effects.
strong, moderate-quality evidence
Clinicians should use low-dose corticosteroids, NSAIDs, or colchicine as options rather than defaulting to one agent for all patients.
The guideline recommends against routinely initiating long-term urate-lowering therapy in most patients after a first gout attack or infrequent flares.
strong, moderate-quality evidence
Clinicians should discuss starting urate-lowering therapy with patients having frequent flares (two or more per year), tophi, or evidence of joint damage from chronic gout.
strong, moderate-quality evidence
For patients who are started on long-term urate-lowering therapy, a treat-to-symptoms strategy (titrating to reduce flares and tophi) is considered a reasonable alternative to strict treat-to-target serum urate monitoring, given insufficient evidence that treat-to-target improves outcomes.
weak/conditional, low-quality evidence
The guideline highlights that evidence is insufficient to clearly favor allopurinol over febuxostat or other urate-lowering agents in terms of comparative long-term benefit.
Routine monitoring of serum urate levels to adjust urate-lowering drug doses against a specific numerical target is not strongly supported by the evidence reviewed.
weak/conditional, low-quality evidence

What is new in this edition

This guideline departs from prior rheumatology-based guidelines (such as ACR) by not endorsing a strict treat-to-target serum urate strategy as the default approach, instead allowing a treat-to-symptoms approach as an alternative.
It frames the decision to start long-term urate-lowering therapy as a shared decision-making discussion rather than a default recommendation after any gout flare.

Practice points for students

Corticosteroids, NSAIDs, and colchicine are considered roughly equivalent for acute flare management; choice should be individualized.
If using colchicine, low-dose regimens are preferred over high-dose due to similar efficacy and better tolerability.
Not every patient with gout needs lifelong urate-lowering therapy; the decision should weigh flare frequency and presence of tophi or joint damage.
This guideline's stance on treat-to-symptoms versus treat-to-target urate monitoring is notably more conservative than rheumatology society guidelines, a useful point of contrast for exams.

Condition

Gout