New guidance by American college of physicians to treat patients with gout

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New guidance by American college of physicians to treat patients with gout

Gout is one of the most painful forms of arthritis, characterized by recurrent attacks of a red, tender, hot, and swollen joint. The joint at the base of the big toe is affected in about half of cases. It may also result in tophi, kidney stones, or urate nephropathy. It occurs due to elevated levels of uric acid in the blood.

The American College of Physicians (ACP) has issued a clinical practice guideline to present the evidence and provide clinical recommendations on the management of gout. Clinical outcomes evaluated included pain, joint swelling and tenderness, activities of daily living, patient global assessment, recurrence, intermediate outcomes of serum urate levels, and harms. Recommendations include:

  • Corticosteroids, nonsteroidal anti-inflammatory drugs (NSAIDs), or colchicine are recommended to treat patients with acute gout.
  • A low-dose colchicine should be used to treat acute gout.
  • It is not recommmended to initiate a long-term urate–lowering therapy in most patients after a first gout attack or in patients with infrequent attack or in with infrequent attacks.
  • Clinicians should discuss benefits, harms, costs, and individual preferences with patients before initiating urate-lowering therapy, including concomitant prophylaxis, in patients with recurrent gout attacks.

The purpose of this guideline is to provide guidance on the management of acute and recurrent gout in adults. These recommendations are based on a background evidence paper and a systematic evidence review sponsored by the Agency for Healthcare Research and Quality (AHRQ). These clinical practice guidelines are developed through a rigorous process based on an extensive review of the highest quality evidence available, including randomized control trials and data from observational studies.

These guidelines focused on a treat-to-avoid symptoms approach rather than a treat-to-target serum urate level strategy. The guideline recommends use of corticosteroids, NSAIDs, or low-dose colchicine for acute gout and avoidance of long-term urate-lowering therapy for the majority of patients after a first attack or for those with infrequent attacks.

Source:

Annals of Internal Medicine

Link to the source:

http://annals.org/aim/article/2578528/management-acute-recurrent-gout-clinical-practice-guideline-from-american-college

Original title of article:

Management of Acute and Recurrent Gout: A Clinical Practice Guideline From the American College of Physicians

Annals of Internal Medicine
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