Management of Gouty Arthritis of the Foot and Ankle : ACFAS/AANP guidance

A joint clinical consensus statement issued by the American College of Foot and Ankle Surgeons and the American Association of Nurse Practitioners (ACFAS/AANP) reports that the use of non-steroidal anti-inflammatory drugs (NSAIDs) for the first-line treatment of gout is appropriate.

The consensus statement published in The Journal of Foot & Ankle Surgery which included 23 individual statements, was developed by a 7-member panel that included 3 podiatric foot and ankle surgeons and 4 nurse practitioners.

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The panel reached a consensus that the following statements were “appropriate”:

• Patients on thiazide diuretics are at higher risk for gout flares.


• Patients with excessive alcohol consumption are at higher risk for gouty flares.


• Diet is a risk factor for gout.


• Diet modification has an effect on decreasing incidence of recurrence.


• Age is a risk factor for gout.


• Standard workup for an initial acute gout episode should include blood uric acid level, erythrocyte sedimentation rate, C-reactive protein, complete blood count, and serum creatinine.


• Advanced imaging is not necessary to diagnose gout.


• Joint aspiration and microscopy are the gold standards for making the diagnosis of gout.


• Nonsteroidal anti-inflammatory drugs should be used as the first-line treatment for acute gout.


• Allopurinol should be titrated until the serum urine uric acid level is <6.0 mg/dL.


• Long-term medications, such as allopurinol, are necessary for the treatment of recurrent gout.


• Multidisciplinary referral provides optimal care in cases of recalcitrant gout.


• Patient education should include dietary modification, medication adherence, and follow-up care with their assigned health care providers.

The panel reached a consensus that the following statement was “inappropriate”:

• Hyperuricemia is always indicative of gout.

The panel reached a consensus that the following statements were “neither appropriate nor inappropriate”:

• Chemotherapy places a patient at higher risk for gout.


• Patients with body mass index >27 are at higher risk for gout.


• Ethnicity, race, and socioeconomics play a great role in regard to the incidence of gout.


• The panel was unable to reach consensus on the following statements:


• Patients with diabetes mellitus are at higher risk for gouty flares.


• Women are not at higher risk for gout.


• Colchicine should be taken daily for 6 to 12 months post-acute gouty flares in patients with recurrent gouty attacks.


• Joint injections are preferred over oral steroids as initial treatment of acute gout.


• Joint implant replacement should be considered in cases of chronic gout.


• Arthroscopic debridement may be used in acute or chronic gout.

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Gout is a condition that commonly affects the foot and ankle. Although the acutely red, hot, swollen joint is a common presentation, chronic tophaceous gout can be associated with pain, nodule formation, and cutaneous compromise.

For full information log on to https://doi.org/10.1053/j.jfas.2018.08.018