2016 updated EULAR evidence-based recommendations for the management of gout
Pascal Richette,Michael Doherty,Eliseo Pascual,V. Barskova,Fabio Becce,Johann Castañeda-Sanabria,M. Coyfish,S Guillo,T.L.Th.A. Jansen,Hein J.E.M. Janssens,Frédéric Lioté,Christian D Mallen,George Nuki,Fernando Perez-Ruiz,J. Pimentao,Leonardo Punzi,T Pywell,Alexander So,Anne-Kathrin Tausche,Till Uhlig,Jakub Zavada,Weiya Zhang,Florence Tubach,Thomas Bardin +23 more
TLDR
In addition to education and a non-pharmacological management approach, urate-lowering therapy (ULT) should be considered from the first presentation of the disease, and serum uric acid (SUA) levels should be maintained at the predefined urate target to cure the disease.Abstract:
Background New drugs and new evidence concerning the use of established treatments have become available since the publication of the first European League Against Rheumatism (EULAR) recommendations for the management of gout, in 2006. This situation has prompted a systematic review and update of the 2006 recommendations.
Methods The EULAR task force consisted of 15 rheumatologists, 1 radiologist, 2 general practitioners, 1 research fellow, 2 patients and 3 experts in epidemiology/methodology from 12 European countries. A systematic review of the literature concerning all aspects of gout treatments was performed. Subsequently, recommendations were formulated by use of a Delphi consensus approach.
Results Three overarching principles and 11 key recommendations were generated. For the treatment of flare, colchicine, non-steroidal anti-inflammatory drugs (NSAIDs), oral or intra-articular steroids or a combination are recommended. In patients with frequent flare and contraindications to colchicine, NSAIDs and corticosteroids, an interleukin-1 blocker should be considered. In addition to education and a non-pharmacological management approach, urate-lowering therapy (ULT) should be considered from the first presentation of the disease, and serum uric acid (SUA) levels should be maintained at<6 mg/dL (360 µmol/L ) and <5 mg/dL (300 µmol/L ) in those with severe gout. Allopurinol is recommended as first-line ULT and its dosage should be adjusted according to renal function. If the SUA target cannot be achieved with allopurinol, then febuxostat, a uricosuric or combining a xanthine oxidase inhibitor with a uricosuric should be considered. For patients with refractory gout, pegloticase is recommended.
Conclusions These recommendations aim to inform physicians and patients about the non-pharmacological and pharmacological treatments for gout and to provide the best strategies to achieve the predefined urate target to cure the disease.read more
Citations
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Journal ArticleDOI
Contemporary Prevalence of Gout and Hyperuricemia in the United States and Decadal Trends: The National Health and Nutrition Examination Survey, 2007–2016
TL;DR: To estimate the current prevalence rates and decadal trends of gout and hyperuricemia in the US, as well as the prevalence of urate‐lowering therapy (ULT) among gout patients, using 2007–2016 data from a nationally representative survey of American men and women (NHANES).
Journal ArticleDOI
2020 American College of Rheumatology Guideline for the Management of Gout.
John FitzGerald,Nicola Dalbeth,Ted R. Mikuls,Romina Brignardello-Petersen,Gordon Guyatt,Aryeh M. Abeles,Allan C. Gelber,Leslie R. Harrold,Dinesh Khanna,Charles H. King,Gerald Levy,Caryn A. Libbey,David B. Mount,Michael H. Pillinger,Ann K. Rosenthal,Jasvinder A. Singh,James Edward Sims,Benjamin J Smith,Neil S. Wenger,Sangmee Sharon Bae,Abhijeet Danve,Puja P. Khanna,Seoyoung C. Kim,Aleksander Lenert,Samuel Poon,Anila Qasim,Shiv T Sehra,Tarun Sharma,Michael Toprover,Marat Turgunbaev,Linan Zeng,Mary Ann Zhang,Amy S. Turner,Tuhina Neogi +33 more
TL;DR: To provide guidance for the management of gout, including indications for and optimal use of urate‐lowering therapy (ULT), treatment of g out flares, and lifestyle and other medication recommendations.
Journal ArticleDOI
Gout: An old disease in new perspective – A review
TL;DR: Gout is a picturesque presentation of uric acid disturbance as mentioned in this paper, it is the most well understood and described type of arthritis. Diagnosis is based on laboratory and radiological features, the gold standard of diagnosis is identification of characteristic MSU crystals in the synovial fluid using polarized light microscopy.
Journal ArticleDOI
Serum uric acid levels and multiple health outcomes: umbrella review of evidence from observational studies, randomised controlled trials, and Mendelian randomisation studies
Xue Li,Xiangrui Meng,Maria Timofeeva,Ioanna Tzoulaki,Konstantinos K. Tsilidis,Konstantinos K. Tsilidis,John P. A. Ioannidis,Harry Campbell,Evropi Theodoratou +8 more
TL;DR: Despite a few hundred systematic reviews, meta-analyses, and Mendelian randomisation studies exploring 136 unique health outcomes, convincing evidence of a clear role of SUA level only exists for gout and nephrolithiasis.
Journal ArticleDOI
Impact of comorbidities on gout and hyperuricaemia: an update on prevalence and treatment options.
Thomas Bardin,Pascal Richette +1 more
TL;DR: Large randomised placebo-controlled trials are still needed to assess the benefits of treating asymptomatic hyperuricaemia, because causality remains uncertain because confounders, reverse causality or common etiological factors might explain the epidemiological results.
References
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Journal ArticleDOI
Gout-associated uric acid crystals activate the NALP3 inflammasome
TL;DR: It is shown that MSU and CPPD engage the caspase-1-activating NALP3 (also called cryopyrin) inflammasome, resulting in the production of active interleukin (IL)-1β and IL-18 in mice deficient in the IL-1β receptor.
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Uric acid and cardiovascular risk.
TL;DR: This review summarizes relevant studies concerning uric acid and possible links to hypertension, renal disease, and cardiovascular disease and presents current evidence.
Journal ArticleDOI
Prevalence of gout and hyperuricemia in the US general population: the National Health and Nutrition Examination Survey 2007-2008.
TL;DR: The findings from nationally representative samples of US adults suggest that the prevalence of both gout and hyperuricemia remains substantial and may have increased over the past 2 decades, which is likely related to increasing frequencies of adiposity and hypertension.
Journal ArticleDOI
2012 American College of Rheumatology guidelines for management of gout. Part 1: Systematic nonpharmacologic and pharmacologic therapeutic approaches to hyperuricemia
Dinesh Khanna,John FitzGerald,Puja P. Khanna,Sangmee Bae,Manjit K. Singh,Tuhina Neogi,Michael H. Pillinger,Joan Merill,Susan J. Lee,Shraddha Prakash,Marian Kaldas,Maneesh Gogia,Fernando Perez-Ruiz,William J. Taylor,Frédéric Lioté,Hyon K. Choi,Jasvinder A. Singh,Nicola Dalbeth,Sanford Kaplan,Vandana Dua Niyyar,Danielle Jones,Steven A. Yarows,Blake J. Roessler,Gail S. Kerr,Charles H. King,Gerald Levy,Daniel E. Furst,N. Lawrence Edwards,Brian F. Mandell,H. Ralph Schumacher,Mark L. Robbins,Neil S. Wenger,Robert Terkeltaub +32 more
TL;DR: DINESH KHanNA, JOHN D. FITZGERALD, PUJA P. KHANNA, SANGMEE BAE, MANJIT K. SINGH, TUHINA NEOGI, MICHAEL H. PILLINGER, JOAN MERILL, SUSAN LEE, SHRADDHA PRAKASH, MARIAN KALDAS, MANEESH GOGIA, FERNANDO PEREZ-RUI
Journal ArticleDOI
EULAR evidence based recommendations for gout. Part II: Management. Report of a task force of the EULAR Standing Committee For International Clinical Studies Including Therapeutics (ESCISIT)
Weiya Zhang,M. Doherty,Thomas Bardin,Eliseo Pascual,V. Barskova,P.G. Conaghan,J Gerster,J Jacobs,Burkhard F. Leeb,Frédéric Lioté,Geraldine M. McCarthy,Patrick Netter,George Nuki,Fernando Perez-Ruiz,A Pignone,J. Pimentao,Leonardo Punzi,Edward Roddy,Till Uhlig,Irena Zimmermann-Górska +19 more
TL;DR: 12 key recommendations for management of gout were developed, using a combination of research based evidence and expert consensus, based on a Delphi consensus approach.
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