Augustin Latourte1, Tristan Pascart2, René-Marc Flipo3, Gérard Chalès4, Laurence Coblentz-Baumann5, Alain Cohen-Solal6, Hang-Korng Ea1, Jacques Grichy7, Emmanuel Letavernier8, Frédéric Lioté1, Sébastien Ottaviani9, Pierre Sigwalt1, Guy Vandecandelaere10, Pascal Richette1, Thomas Bardin11. 1. Service de rhumatologie, hôpital Lariboisière, AP-HP, 2, rue Ambroise-Paré, 75010 Paris, France; Inserm U1132 BIOSCAR, université de Paris, Paris, France. 2. Service de rhumatologie, université de Lille, GH de l'institut catholique de Lille, Lille, France; EA4490, physiopathologie des maladies osseuses inflammatoires, université de Lille, Lille, France. 3. Service de rhumatologie, université de Lille, CHU de Lille, Lille, France. 4. Faculté de médecine de Rennes, Rennes, France. 5. Département de médecine générale, université de Paris, Paris, France. 6. Service de cardiologie, hôpital Lariboisière, AP-HP, Paris, France; Inserm U942 MASCOT, université de Paris, Paris, France. 7. Private practice, Montlignon, France. 8. Service de physiologie, hôpital Tenon, AP-HP, Paris, France; Inserm U1155, UPMC Université Paris 6, Sorbonne Universités, Paris, France. 9. Service de rhumatologie, hôpital Bichat, AP-HP, Paris, France. 10. Département de médecine générale, université de Lille, Lille, France. 11. Service de rhumatologie, hôpital Lariboisière, AP-HP, 2, rue Ambroise-Paré, 75010 Paris, France; Inserm U1132 BIOSCAR, université de Paris, Paris, France. Electronic address: francethomas.bardin@aphp.fr.
Abstract
OBJECTIVE: To develop French Society of Rheumatology-endorsed recommendations for the management of gout flares. METHODS: These evidence-based recommendations were developed by 9 rheumatologists (academic or community-based), 3 general practitioners, 1 cardiologist, 1 nephrologist and 1 patient, using a systematic literature search, one physical meeting to draft recommendations and 2 Delphi rounds to finalize them. RESULTS: A set of 4 overarching principles and 4 recommendations was elaborated. The overarching principles emphasize the importance of patient education, including the need to auto-medicate for gout flares as early as possible, if possible within the first 12h after the onset, according to a pre-defined treatment. Patients must know that gout is a chronic disease, often requiring urate-lowering therapy in addition to flare treatment. Comorbidities and the risk of drug interaction should be screened carefully in every patient as they may contraindicate some anti-inflammatory treatments. Colchicine must be early prescribed at the following dosage: 1mg then 0.5mg one hour later, followed by 0.5mg,2 to 3 times/day over the next days. In case of diarrhea, which is the first symptom of colchicine poisoning, dosage must be reduced. Colchicine dosage must also be reduced in patients with chronic kidney disease or taking drugs, which interfere with its metabolism. Other first-line treatment options are systemic/intra-articular corticosteroids, or non-steroidal anti-inflammatory agents (NSAIDs). IL-1 inhibitors can be considered as a second-line option in case of failure, intolerance or contraindication to colchicine, corticosteroids and NSAIDs. They are contraindicated in cases of infection and neutrophil blood count should be monitored. CONCLUSION: These recommendations aim to provide strategies for the safe use of anti-inflammatory agents, in order to improve the management of gout flares.
OBJECTIVE: To develop French Society of Rheumatology-endorsed recommendations for the management of gout flares. METHODS: These evidence-based recommendations were developed by 9 rheumatologists (academic or community-based), 3 general practitioners, 1 cardiologist, 1 nephrologist and 1 patient, using a systematic literature search, one physical meeting to draft recommendations and 2 Delphi rounds to finalize them. RESULTS: A set of 4 overarching principles and 4 recommendations was elaborated. The overarching principles emphasize the importance of patient education, including the need to auto-medicate for gout flares as early as possible, if possible within the first 12h after the onset, according to a pre-defined treatment. Patients must know that gout is a chronic disease, often requiring urate-lowering therapy in addition to flare treatment. Comorbidities and the risk of drug interaction should be screened carefully in every patient as they may contraindicate some anti-inflammatory treatments. Colchicine must be early prescribed at the following dosage: 1mg then 0.5mg one hour later, followed by 0.5mg,2 to 3 times/day over the next days. In case of diarrhea, which is the first symptom of colchicinepoisoning, dosage must be reduced. Colchicine dosage must also be reduced in patients with chronic kidney disease or taking drugs, which interfere with its metabolism. Other first-line treatment options are systemic/intra-articular corticosteroids, or non-steroidal anti-inflammatory agents (NSAIDs). IL-1 inhibitors can be considered as a second-line option in case of failure, intolerance or contraindication to colchicine, corticosteroids and NSAIDs. They are contraindicated in cases of infection and neutrophil blood count should be monitored. CONCLUSION: These recommendations aim to provide strategies for the safe use of anti-inflammatory agents, in order to improve the management of gout flares.
Authors: Wan Syamimee Wan Ghazali; Wan Mohd Khairul Bin Wan Zainudin; Nurul Khaiza Yahya; Asmahan Mohamed Ismail; Kah Keng Wong Journal: PeerJ Date: 2021-05-20 Impact factor: 2.984