2016 Eular Guidelines

Content

• Clinical Pearls
• Study Design And Participants
• Two Studies Offer Promising News For Lupus Patients
• Uf Health
• Uf Health At Gainesville

shows the treatment modalities addressed in the 98 studies related to management; 86% of publications related to pharmacological treatments ; 3% to herbal remedies; and 11% to non‐pharmacological treatment . Although a broad range of treatments have been used to manage gout only those agreed using the Delphi consensus approach were assessed. Figure 2​ 2 shows the categories of evidence according to study designs for the 98 management related studies. EULAR hopes that these new recommendations will be included in different educational programs, used by patient associations, and that they will be implemented through scientific societies to help improve the uniformity and quality of care when performing IAT.

While new pharmacological treatments can be effective in managing gout flares, pharmacological treatments must be applied with patient education, the authors stressed repeatedly in the article. Fostering an environment in which patients take an active role in controlling flares - through medication adherence and lifestyle changes - is essential. “The task force is convinced that patients must play a key role and be fully involved in the management of their disease,” the authors wrote. Citing multiple studies, the authors say that urate-lowering therapy , specifically allopurinol, should be considered at first presentation of a flare. If this fails, then febuxostat, or a combination of a xanthine oxidase inhibitor with a uricosuric, should be considered.

Clinical Pearls

COX-2 inhibitors are a type of nonsteroidal anti-inflammatory drug that directly targets cyclooxygenase-2, COX-2, an enzyme responsible for inflammation and pain. Targeting selectivity for COX-2 reduces the risk of peptic ulceration and is the main feature of celecoxib, rofecoxib, and other members of this drug class. Although IAT is commonly performed, there is variation in how, why, and where it is done. EULAR aimed to help standardize the way IAT is delivered, and explain to people what they can expect from the treatment. A EULAR taskforce was set up to develop a set of new recommendations to give guidance and advice on best practice for IAT.

How do you diagnose gout diagnosis?

Tests to help diagnose gout may include: 1. Joint fluid test. Your doctor may use a needle to draw fluid from your affected joint.
2. Blood test. Your doctor may recommend a blood test to measure the levels of uric acid in your blood.
3. X-ray imaging.
4. Ultrasound.
5. Dual-energy computerized tomography (DECT).

In general, its adverse events are mild, and it can be prescribed to patients with chronic kidney disease. Due to previous hepatotoxicity reports and experimental evidence gathered so far, it is reasonable to recommend active monitoring of hepatic function and enzymes and avoid its use in patients with known hepatic disease or asymptomatic hyperuricemia. Long-term prophylaxis with urate lowering therapy is used to maintain serum urate levels below 6 mg/dL, while considering the individual needs of the patient. Xanthine oxidase inhibitors , uricosuric, and uricase agents are three classes of drugs approved for lowering urate levels to help prevent acute flares and development of tophi in patients with gout. Apart from hypertension, hyperlipidaemia and other features of the metabolic syndrome are also associated with gout. Fenofibrate showed significant reduction of SUA by 20% (95% CI, 14% to 26%) with an effect size of 1.13 (0.18 to 2.07).

Study Design And Participants

Calculations must be re-checked and should not be used alone to guide patient care, nor should they substitute for clinical judgment. MDCalc loves calculator creators – researchers who, through intelligent and often complex methods, discover tools that describe scientific facts that can then be applied in practice. These are real scientific discoveries about the nature of the human body, which can be invaluable to physicians taking care of patients.

The 95% confidence interval of the NNT was calculated using Altman's method.7 The dose–response relation between drug treatment and effects was analysed using a linearity test. Individual patient data were obtained from the original reports for this analysis and the results were pooled as appropriate. A multiple regression model was used to adjust co‐variables such as concomitant treatment, age, sex, length of the disease, and duration of the treatment. In healthy subjects and in subjects with hyperuricemia, the drug was shown to increases urate clearance by 500%, leading to an average reduction in sUA of 25–50% . A study from 2002 compared the efficacy of 100 mg benzbromarone to 300 mg allopurinol. The study reported a significantly larger reduction in sUA from the benzbromarone (9.53 +/− 1.48 to 4.05 +/− 0.87 mg/dl) compared to allopurinol (9.89 +/− 1.43 mg/dl to 5.52 +/− 0.83 mg/dl) .

Clinical

Using Kaplan-Meier plots, we estimated cumulative probabilities of patients fulfilling current indications for urate-lowering treatment 1,2 and receiving treatment. Gout diagnosis and treatment indications were ascertained using physician diagnosis, laboratory results, and prescriptions. Variations in prescription rates explained by patient-level factors and practice-level factors were calculated using a 2-level linear model.

The Gout Education Society

The paper, published this January 2021 in Seminars in Arthritis and Rheumatism,3 presented a consensus-based, semi-quantitative ultrasound scoring system for grading gout lesions. The scoring system was developed by a working group of rheumatologists from 14 countries – the Outcome Measure in Rheumatology Gout Group. The mean age of participants was 64.7 years old with a mean duration of symptoms of 9.2 years. Of the 147 participants, 131 were clinically diagnosed with gout by the attending rheumatologist.

Benzbromarone is a safe and effective molecule for the treatment of gout. However, due to in vitro and in vivo data related to hepatotoxicity, it is prudent to prescribe it with some caution, especially for patients with an already known liver condition. A study shows gout patients who received daily text messages reminding them to take their allopurinol were much likelier to take the uric acid-lowering medication than those who didn’t receive messages.

Despite the product’s marketing over more than 20 years after the first hepatotoxicity reports, we have found only five reports in our literature search, and no prospective or retrospective study correlating hepatotoxicity with benzbromarone use. Starting ULT usually causes an increase in acute gout attacks for a few months; therefore, prophylaxis with colchicine or an NSAID over a period of several months will be needed to mitigate the flares, according to the ACP, ACR 2012, and EULAR 2016 guidelines. The ACP guideline states that moderate-quality evidence suggests that this therapy is more effective at reducing gout flares if taken longer than 8 weeks. Finally, we observed that the initiation of febuxostat during an acute gout flare did not prolong the duration of the flare. The mean sUA levels in the febuxostat group were lower compared with the placebo group, and the rate of recurrent gout flares did not increase in patients that were administered febuxostat.

The principles say that ITT is recommended and widely used in the management of joint diseases and that the technique aims to improve patient-centered outcomes. They also emphasize that contextual factors are important and contribute to the effect of IAT. As such, ITV should be offered as part of a comprehensive set of individualized information and a shared decision-making process. Finally, they recognize that there is a wide variety of health professionals they are able to perform these procedures routinely. The individual recommendations cover information on the type of support and advice that people undergoing ITV should expect to receive from their healthcare team.

Is Chicken OK for gout?

Meats like fish, chicken, and red meat are fine in moderation (around 4 to 6 ounces per day). Vegetables: You may see veggies like spinach and asparagus on the high-purine list, but studies show they don't raise your risk of gout or gout attacks.