Based on a systematic review of randomized controlled trials, systematic reviews, and large observational studies between January 2010 and March 2016, the American College of Physicians (ACP) developed guidelines to offer 4 clinical recommendations on the management of gout:

1. For acute gout, corticosteroids, nonsteroidal anti-inflammatory drugs, or colchicines. (Grade: strong recommendation, high-quality evidence)

2. For acute gout, low-dose colchicines. (Grade: strong recommendation, moderate-quality evidence)

3. After a first gout attack or for patients with infrequent attacks, ACP recommends against initiating long-term urate-lowering therapy in most patients. (Grade: strong recommendation, moderate-quality evidence)

4. In patients with recurrent gout attacks, clinicians should discuss benefits, harms, costs, and individual preferences before initiating urate-lowering therapy, including concomitant prophylaxis. (Grade: strong recommendation, moderate-quality evidence) (See Qaseem A, Harris RP, Forciea MA. Management of acute and recurrent gout: a Clinical Practice Guideline from the American College of Physicians. Ann Intern Med. 2017;166(1):58-68.