2016 EULAR guidelines: The most important change in gout management

What are the new implications for clinical practice of the new 2016 European League Against Rheumatism (EULAR) recommendations for the management of gout?

George Nuki: There are many. But I think that probably the most important change is that one should discuss with the patient and think about the possibility of starting urate-lowering therapy even at the time of the first attack.

Obviously, ultimately, that is the patient’s decision. Some patients, even after they have been informed that they have crystal deposition and that there are risks to having ongoing inflammation with regard to that, will say, “Look, if you tell me that I am not likely to have another attack for a year, I would prefer to wait.” There are other patients who will say, “My god, that was so bad that if I can do anything to stop me having that again...” and they will change their lifestyle and they will start taking urate-lowering drugs. Ultimately, these are always patient-doctor decisions together, and ultimately the patient has to decide.