Dataset Information

2020 American College of Rheumatology Guideline for the Management of Gout.

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.

SUBMITTER: FitzGerald JD

PROVIDER: S-EPMC10563586 | biostudies-literature | 2020 Jun

REPOSITORIES: biostudies-literature

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Publications

2020 American College of Rheumatology Guideline for the Management of Gout.

FitzGerald John D JD Dalbeth Nicola N Mikuls Ted T Brignardello-Petersen Romina R Guyatt Gordon G Abeles Aryeh M AM Gelber Allan C AC Harrold Leslie R LR Khanna Dinesh D King Charles C Levy Gerald G Libbey Caryn C Mount David D Pillinger Michael H MH Rosenthal Ann A Singh Jasvinder A JA Sims James Edward JE Smith Benjamin J BJ Wenger Neil S NS Bae Sangmee Sharon SS Danve Abhijeet A Khanna Puja P PP Kim Seoyoung C SC Lenert Aleksander A Poon Samuel S Qasim Anila A Sehra Shiv T ST Sharma Tarun Sudhir Kumar TSK Toprover Michael M Turgunbaev Marat M Zeng Linan L Zhang Mary Ann MA Turner Amy S AS Neogi Tuhina T

Arthritis care & research 20200511 6

<h4>Objective</h4>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.<h4>Methods</h4>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, Develo ...[more]

PMID: 32391934

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Project description:ObjectiveTo develop an evidence-based guideline for the comprehensive management of osteoarthritis (OA) as a collaboration between the American College of Rheumatology (ACR) and the Arthritis Foundation, updating the 2012 ACR recommendations for the management of hand, hip, and knee OA.MethodsWe identified clinically relevant population, intervention, comparator, outcomes questions and critical outcomes in OA. A Literature Review Team performed a systematic literature review to summarize evidence supporting the benefits and harms of available educational, behavioral, psychosocial, physical, mind-body, and pharmacologic therapies for OA. Grading of Recommendations Assessment, Development and Evaluation methodology was used to rate the quality of the evidence. A Voting Panel, including rheumatologists, an internist, physical and occupational therapists, and patients, achieved consensus on the recommendations.ResultsBased on the available evidence, either strong or conditional recommendations were made for or against the approaches evaluated. Strong recommendations were made for exercise, weight loss in patients with knee and/or hip OA who are overweight or obese, self-efficacy and self-management programs, tai chi, cane use, hand orthoses for first carpometacarpal (CMC) joint OA, tibiofemoral bracing for tibiofemoral knee OA, topical nonsteroidal antiinflammatory drugs (NSAIDs) for knee OA, oral NSAIDs, and intraarticular glucocorticoid injections for knee OA. Conditional recommendations were made for balance exercises, yoga, cognitive behavioral therapy, kinesiotaping for first CMC OA, orthoses for hand joints other than the first CMC joint, patellofemoral bracing for patellofemoral knee OA, acupuncture, thermal modalities, radiofrequency ablation for knee OA, topical NSAIDs, intraarticular steroid injections and chondroitin sulfate for hand OA, topical capsaicin for knee OA, acetaminophen, duloxetine, and tramadol.ConclusionThis guideline provides direction for clinicians and patients making treatment decisions for the management of OA. Clinicians and patients should engage in shared decision-making that accounts for patients' values, preferences, and comorbidities. These recommendations should not be used to limit or deny access to therapies.

Dataset Information

2020 American College of Rheumatology Guideline for the Management of Gout.

Objective

Methods

Results

Conclusion

Publications

2020 American College of Rheumatology Guideline for the Management of Gout.

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