Discordant American College of Physicians and international rheumatology guidelines for gout management: consensus statement of the Gout, Hyperuricemia and Crystal-Associated Disease Network (G-CAN)

Abstract

Gout is a common form of inflammatory arthritis for which highly effective treatments are available, yet the management of this disease is frequently suboptimal. Gout often presents as an acute 'flare' of painful inflammation that typically resolves within a week or two, but can be difficult to control in some instances, can negatively affect quality of life, can be costly to experience and treat, and can warrant hospital admission. If gout-associated hyperuricaemia is inadequately treated, gout flares often progress in frequency and severity, and a state of chronic, inflammatory arthritis can supervene, leading to continuous pain, decreased joint function, and permanent joint damage.Guidelines for the management of gout are intended to help physicians select the most effective course of treatment and to educate patients in order to ensure adherence. In November 2016, the American College of Physicians (ACP) published a clinical practice guideline for the management of acute and recurrent gout 1 . Despite evaluating similar evidence, the ACP clinical practice guideline differs substantially from all other gout management guidelines issued by major international rheumatology groups in the past 5 years, including the 2012 Abstract | In November 2016, the American College of Physicians (ACP) published a clinical practice guideline on the management of acute and recurrent gout. This guideline differs substantially from the latest guidelines generated by the American College of Rheumatology (ACR), European League Against Rheumatism (EULAR) and 3e (Evidence, Expertise, Exchange) Initiative, despite reviewing largely the same body of evidence. The Gout, Hyperuricemia and Crystal-Associated Disease Network (G-CAN) convened an expert panel to review the methodology and conclusions of these four sets of guidelines and examine possible reasons for discordance between them. The G-CAN position, presented here, is that the fundamental pathophysiological knowledge underlying gout care, and evidence from clinical experience and clinical trials, supports a treat-to-target approach for gout aimed at lowering serum urate levels to below the saturation threshold at which monosodium urate crystals form. This practice, which is truly evidence-based and promotes the steady reduction in tissue urate crystal deposits, is promoted by the ACR, EULAR and 3e Initiative recommendations. By contrast, the ACP does not provide a clear recommendation for urate-lowering therapy (ULT) for patients with frequent, recurrent flares or those with tophi, nor does it recommend monitoring serum urate levels of patients prescribed ULT. Results from emerging clinical trials that have gout symptoms as the primary end point are expected to resolve this debate for all clinicians in the near term future. NATURE REVIEWS | RHEUMATOLOGY VOLUME 13 | SEPTEMBER 2017 | 561 CONSENSUS STATEMENT © 2 0 1 7 M a c m i l l a n P u b l i s h e r s L i m i t e d , p a r t o f S p r i n g e r N a t u r e . A l l r i g h t s r e s e r v e d . UricaseAn enzyme that degrades ur...

Chinese herbal medicine si-miao-san decoction for acute gouty arthritis

“…Both groups received conventional gout treatment recommended by ACR guidelines, including diet and lifestyle. [ 11 ] The experiment group used SMSD or modified SMSD, while the control group applied for no intervention, placebo, or conventional medication such as non-steroid anti-inflammatory drugs, colchicines, steroids, and adrenocorticotrophic hormone. In addition, the 2 groups did not take any drugs that interfered with the outcome indicators.…”

Non-pharmacologic measures for gout management in the prospective GOSPEL cohort: Physicians’ practice and patients’ compliance profiles

“…and consumption of food rich in purines (9). Excessive alcohol consumption was defined as more than three glasses of alcohol per day for men and two glasses of alcohol per day for women (18).…”

Uji Efektifitas Ekstras Etanol Buah Naga Putih (Hylocereus undatus) Terhadap Penurunan Kadar Asam Urat Darah Pada Mencit (Mus musculus)

“…Allopurinol didalam tubuh mengalami metabolisme menjadi oksipurinol (alozantin) yang juga bekerja sebagai penghambat enzim xantin oksidase dan mengurangi produksi asam urat tanpa mengganggu biosintesa purin (9) . Manajemen obat untuk menurunkan kadar asam urat harus diperhitungkan dengan tepat, karena dengan pemberian allopurinol dapat menimbulkan efek samping berupa hipersensitivitas allopurinol sindrom (AHS), diantaranya reaksi nyeri kepala, alergi kulit dan lainnya (10) .…”