A most noteworthy “new recommendation” different from the ACR one is this:
“urate-lowering therapy (ULT) should be considered from the first presentation of the disease“.
Yes. Effectively lifelong treatment from the first flare. Because we are increasingly aware of the dire consequences of hyperuricaemia to renal and cardiovascular health. And hyperuricaemia is a lifestyle inflammatory metabolic disorder, like diabetes and obesity, that is not going to spontaneously remit.
New EULAR gout guidelines garner praise, criticism
For those more inclined towards more “natural” remedies, Quercetin may be of interest. However, effects are modest: 100g of red onions a day lowers serum uric acid by an average of 8%. This is unlikely to help anyone with Gout to achieve target serum uric acid level of below 6 mg% (360 umol/L).
Even a measure as drastic as weight reduction surgery yields an average of 10% reduction in serum uric acid level. Bottom line, Gout sufferers can’t solve their problem without urate lowering therapy (ULT).
Bariatric surgery is of course useful to address other concomitant conditions like obesity and diabetes.