2020 American College of Rheumatology Guideline for the Management of Gout
Arthritis rheumatol. (Malden. Online)
; 72(6): [879895], June 2020.
Article
in English
| BIGG - GRADE guidelines
| ID: biblio-1117200
Responsible library:
BR1.1
ABSTRACT
To provide guidance for the management of gout, including indications for and optimal use of urate- lowering therapy (ULT), treatment of gout îares, and lifestyle and other medication recommendation 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 înal recommendations and grade their strength as strong or conditional.Results. Forty- two recommendations (including 16 strong recommendations) were generated. Strong recommen-dations included initiation of ULT for all patients with tophaceous gout, radiographic damage due to gout, or frequent gout îares; allopurinol as the preferred îrst- 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 antiinîammatory prophylaxis therapy for a duration of at least 36 months was strongly recommended. For management of gout îares, colchicine, nonsteroidal antiinîammatory 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.
Full text:
Available
Collection:
Tematic databases
Database:
BIGG - GRADE guidelines
Main subject:
Uric Acid
/
Anti-Inflammatory Agents, Non-Steroidal
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Allopurinol
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Febuxostat
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Gout
Type of study:
Practice guideline
/
Prognostic study
Language:
English
Journal:
Arthritis rheumatol. (Malden. Online)
Year:
2020
Document type:
Article