John D FitzGerald1, Nicola Dalbeth2, Ted Mikuls3, Romina Brignardello-Petersen4, Gordon Guyatt4, Aryeh M Abeles5, Allan C Gelber6, Leslie R Harrold7, Dinesh Khanna8, Charles King9, Gerald Levy10, Caryn Libbey11, David Mount12, Michael H Pillinger5, Ann Rosenthal13, Jasvinder A Singh14, James Edward Sims15, Benjamin J Smith16, Neil S Wenger17, Sangmee Sharon Bae17, Abhijeet Danve18, Puja P Khanna19, Seoyoung C Kim20, Aleksander Lenert21, Samuel Poon22, Anila Qasim4, Shiv T Sehra23, Tarun Sudhir Kumar Sharma24, Michael Toprover5, Marat Turgunbaev25, Linan Zeng4, Mary Ann Zhang20, Amy S Turner25, Tuhina Neogi11. 1. University of California, Los Angeles and VA Greater Los Angeles Health Care System, Los Angeles, California. 2. University of Auckland, Auckland, New Zealand. 3. University of Nebraska Medical Center and VA Nebraska-Western Iowa Health Care System, Omaha, Nebraska. 4. McMaster University, Hamilton, Ontario, Canada. 5. New York University School of Medicine, New York City, New York. 6. Johns Hopkins University, Baltimore, Maryland. 7. University of Massachusetts Medical School, Worcester Massachusetts, and Corrona, Waltham, Massachusetts. 8. University of Michigan, Ann Arbor. 9. North Mississippi Medical Center, Tupelo. 10. Kaiser Permanente, Downey, California. 11. Boston University School of Medicine, Boston, Massachusetts. 12. VA Boston Healthcare System, Boston, Massachusetts. 13. Medical College of Wisconsin, Milwaukee. 14. University of Alabama at Birmingham and Birmingham Veterans Affairs Medical Center, Birmingham. 15. Atlanta, Georgia. 16. Florida State University College of Medicine School of Physician Assistant Practice, Tallahassee. 17. University of California, Los Angeles. 18. Yale University, New Haven, Connecticut. 19. University of Michigan, VA Ann Arbor Healthcare System, Ann Arbor. 20. Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts. 21. University of Kentucky, Lexington. 22. US Department of Veterans Affairs, Manchester, New Hampshire. 23. Mount Auburn Hospital, Cambridge, Massachusetts. 24. Allegheny Health Network, Pittsburgh, Pennsylvania. 25. American College of Rheumatology, Atlanta, Georgia.
Abstract
OBJECTIVE: To provide guidance for the management of gout, including indications for and optimal use of urate-lowering therapy (ULT), treatment of gout flares, and lifestyle and other medication recommendations. METHODS: Fifty-seven population, intervention, comparator, and outcomes questions were developed, followed by a systematic literature review, including network meta-analyses with ratings of the available evidence according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology, and patient input. A group consensus process was used to compose the final recommendations and grade their strength as strong or conditional. RESULTS: Forty-two recommendations (including 16 strong recommendations) were generated. Strong recommendations included initiation of ULT for all patients with tophaceous gout, radiographic damage due to gout, or frequent gout flares; allopurinol as the preferred first-line ULT, including for those with moderate-to-severe chronic kidney disease (CKD; stage >3); using a low starting dose of allopurinol (≤100 mg/day, and lower in CKD) or febuxostat (<40 mg/day); and a treat-to-target management strategy with ULT dose titration guided by serial serum urate (SU) measurements, with an SU target of <6 mg/dl. When initiating ULT, concomitant antiinflammatory prophylaxis therapy for a duration of at least 3-6 months was strongly recommended. For management of gout flares, colchicine, nonsteroidal antiinflammatory drugs, or glucocorticoids (oral, intraarticular, or intramuscular) were strongly recommended. CONCLUSION: Using GRADE methodology and informed by a consensus process based on evidence from the current literature and patient preferences, this guideline provides direction for clinicians and patients making decisions on the management of gout.
OBJECTIVE: To provide guidance for the management of gout, including indications for and optimal use of urate-lowering therapy (ULT), treatment of gout flares, and lifestyle and other medication recommendations. METHODS: Fifty-seven population, intervention, comparator, and outcomes questions were developed, followed by a systematic literature review, including network meta-analyses with ratings of the available evidence according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology, and patient input. A group consensus process was used to compose the final recommendations and grade their strength as strong or conditional. RESULTS: Forty-two recommendations (including 16 strong recommendations) were generated. Strong recommendations included initiation of ULT for all patients with tophaceous gout, radiographic damage due to gout, or frequent gout flares; allopurinol as the preferred first-line ULT, including for those with moderate-to-severe chronic kidney disease (CKD; stage >3); using a low starting dose of allopurinol (≤100 mg/day, and lower in CKD) or febuxostat (<40 mg/day); and a treat-to-target management strategy with ULT dose titration guided by serial serum urate (SU) measurements, with an SU target of <6 mg/dl. When initiating ULT, concomitant antiinflammatory prophylaxis therapy for a duration of at least 3-6 months was strongly recommended. For management of gout flares, colchicine, nonsteroidal antiinflammatory drugs, or glucocorticoids (oral, intraarticular, or intramuscular) were strongly recommended. CONCLUSION: Using GRADE methodology and informed by a consensus process based on evidence from the current literature and patient preferences, this guideline provides direction for clinicians and patients making decisions on the management of gout.
Authors: Nagisa Morikawa; Michael P Bancks; Yuichiro Yano; Masanari Kuwabara; Angelo L Gaffo; Daniel A Duprez; Myron D Gross; David R Jacobs Journal: Hypertension Date: 2021-06-07 Impact factor: 10.190
Authors: Edoardo Cipolletta; Jacopo Di Battista; Marco Di Carlo; Andrea Di Matteo; Fausto Salaffi; Walter Grassi; Emilio Filippucci Journal: Arthritis Res Ther Date: 2021-07-09 Impact factor: 5.156