New Clinical Consensus Statement Designed to Address Controversies in Pathophysiology & Treatment of Gout


ACFAS & American Association of Nurse Practitioners® Publish Interdisciplinary, Joint Statement

CHICAGO-Oct. 25, 2019-ACFAS and the American Association of Nurse Practitioners® have developed a joint clinical consensus statement on gouty arthritis localized to the foot and ankle. Published in the November/December issues of The Journal of Foot & Ankle Surgery and The Journal for Nurse Practitioners, the statement is intended to serve as a discussion guide for the risk factors, diagnosis, treatment and prevention of the disease.

"Gout is a condition that commonly affects the foot and ankle, and practitioners who treat these structures should be aware of the methods used to diagnose and treat this form of arthritis, and also to recognize extra-articular manifestations of the disease," said the guideline's lead author Roya Mirmiran, DPM, FACFAS, a foot and ankle surgeon at Sutter Medical Group in Sacramento, CA and a Fellow Member of ACFAS. "Using the best available evidence, clinical experience and common sense, we were able to reach joint consensus on 17 of 23 statements on the etiology, diagnosis and treatment of gout in the foot and ankle."

Among the papers significant agreements are:

•    Age, diet and alcohol consumption are risk factors for 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.
•    Long-term medications, such as allopurinol, are necessary in 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 healthcare providers.

"In working with an interprofessional team, we have been able to create a thorough consensus statement for the management of patients with gout," said co-chair Michael Zychowicz, DNP, ANP, FAAN, FAANP, Professor and Director of the MSN Program & Lead Faculty in Orthopedic NP Specialty at Duke University School of Nursing in Durham, NC. "This document will serve as a valuable clinical guide for the interprofessional management of gout arthritis."

"We are delighted for the opportunity to collaborate with our podiatric surgical colleagues on this clinical consensus statement," said Tom Bush, DNP, FNP-BC, FAANP, Assistant Dean of the University of North Carolina at Chapel Hill School of Nursing and a faculty member in the UNC Department of Orthopedic Surgery. "NPs and podiatrists have complementary skills and experience to provide comprehensive care to preserve joint function and treat complications of this age-old disease."  

"As a patient's first point of contact, nurse practitioners, specifically those with orthopaedic specialty, were the natural and optimal profession with which to collaborate for the development of this joint consensus statement," said John S. Steinberg, DPM, FACFAS, president, American College of Foot and Ankle Surgeons. "Together, foot and ankle surgeons and nurse practitioners can provide the best, collaborative care for patients suffering from gout, and we hope that this paper serves as a guide for all medical professionals whose patients are at risk for or are currently being treated for the disease."

"The American Association of Nurse Practitioners® is delighted to have worked with ACFAS in the development of a joint clinical consensus statement on the etiology, diagnosis and treatment of gouty arthritis localized to the foot and ankle," said AANP President Joyce Knestrick, PhD, C-FNP, APRN, FAANP. "This joint consensus statement is unique in that it is derived based on an interdisciplinary team approach.

To read the full joint clinical consensus statement on gouty arthritis, visit or


Educational Opportunities