Management of Gout: Review Support of an American College of Physicians Clinical Practice Guideline

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Management of Gout: Review Support of an American College of Physicians Clinical Practice Guideline

Gout is another form of inflammatory arthritis and is the most common inflammatory arthritis globally. Gout is defined by the acute sporadic occurrence of synovitis which results in inflammation of the joint and pain. Approximately 8 million of the population in the United States is reported to have gout. In gout, excess urate in the body crystallizes (such as monosodium urate) in the joint fluid including cartilage, bones, tendons, bursas or other sites of the body, which can instantly result in the inflammatory attack.

The acute gout attacks were reported to be increased in some patients and had also developed tophi (clusters of urate crystals at the surface of joints or in skin cartilage). A systematic review was also planned by American College of Physicians (ACP) to support the management of practice guidelines in which primary care practitioners will discuss the establishment of adult patients having gout.

Shekelle P G, et al.,conducted a review on the treatment of gout attacks and management of hyperuricemia for prevention. Further, the discontinuation of medications for chronic gout was also discussed. In this review, studies approved by U.S. Food and Drug Administration and studies on commonly prescribed treatments by primary care physicians, and randomized trials for effectiveness.

Of all the included studies, 28 studies showed that colchicine, NSAIDs, and corticosteroids reduce the pain in patients with acute gout. Moderate-strength evidence suggested that the low-dose colchicine causes less gastrointestinal adverse events. It was also suggested that urate-lowering therapy reduces the long-term risk of acute gout attacks after one year or more. Prophylaxis of colchicine and NSAIDs also reduce the risk for acute gout attacks by at-least in half of the patients which started urate-lowering therapy and among them, a moderate-strength evidence indicates that duration of prophylaxis should be longer than 8 weeks. However, the lower urate levels reduce the risk of the frequency of acute attacks, but treatment to a specific target level is yet to be tested.

Although there are some limitations to this review, it can be stated that Colchicine, NSAIDs, and Corticosteroids can help relieve the pain associated with gout in adults. Serum urate levels can be reduced by urate-lowering therapy, which further reduces the risk of gout attacks.

Source:

Annals of Internal Medicine

Link to the source:

http://annals.org/aim/article/2578526/management-gout-systematic-review-support-american-college-physicians-clinical-practice

The original title of the article:

Management of Gout: A Systematic Review in Support of an American College of Physicians Clinical Practice Guideline.

Authors:

Paul G. Shekelle et al.

SearchTags: 
Therapeutic, Colchicine, Gout, Joints, Anti-inflammatory, NSAIDs, Corticosteroids, Clinical Practice Guideline
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