Effect of urate‐lowering therapy on the velocity of size reduction of tophi in chronic gout

Pérez-Ruiz, Fernando; Calabozo, M; Pijoán, José Ignacio; Herrero-Beites, Ana María; Ruibal, A

doi:10.1002/art.10511

Cited by 405 publications

(261 citation statements)

References 27 publications

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“…The velocity of crystal dissolution is dependent on the urate concentration 23,24 . Long-term studies have shown the clear clinical benefit of treating patients with urate-lowering therapy (ULT) to reach target serum urate levels, with complete suppression of flares, regression of tophi and improvement in quality of life over time 21,[25][26][27][28][29][30] . Bone erosions due to tophaceous gout also have been shown to heal after expedited eradication of tissue MSU crystal deposits by use of pegloticase therapy 31 .…”

Section: Rationale For the G-can Positionmentioning

confidence: 99%

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)

et al. 2017

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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...

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Section: Rationale For the G-can Positionmentioning

confidence: 99%

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)

et al. 2017

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“…It is shown that recurrent gouty attacks are better prevented [12,13] and that tophi dissolve more quickly [14] in the presence of sUr levels ≤0.30 mmol/l, compared with levels 0.30-0.36 mmol/l. Thus, we aimed the sUr treatment goal for gout patients at ≤0.30 mmol/l.…”

Section: Introductionmentioning

confidence: 99%

Biochemical effectiveness of allopurinol and allopurinol-probenecid in previously benzbromarone-treated gout patients

et al. 2007

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“…(9,10) Tophus size was also demonstrated to reduce more rapidly in patients with lower SUA levels. (11) …”

Section: Introductionmentioning

confidence: 99%

Poorly controlled gout: who is doing poorly?

Chia¹

2016

smedj

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Gout, an inflammatory arthritis caused by the deposition of monosodium urate crystals, is commonly seen in primary care and specialist clinics. In recent years, there has been a resurgence of interest in gout due to advances in therapies and the understanding of pathophysiology, with new guidelines being published by international bodies. However, there is still a gap between the goals of treatment and actual day-to-day practice. Barriers that result in poorly controlled gout include patient factors such as lack of understanding of the disease, stigma and nonadherence to treatment, as well as physician factors such as knowledge gaps, inadequate use of allopurinol and lack of ownership of the disease. The medical profession needs to do more to bridge the gap through physician and patient education, identification of treatment targets with appropriate use of drugs, and dissemination of guidelines.

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Effect of urate‐lowering therapy on the velocity of size reduction of tophi in chronic gout

Cited by 405 publications

References 27 publications

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)

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)

Biochemical effectiveness of allopurinol and allopurinol-probenecid in previously benzbromarone-treated gout patients

Poorly controlled gout: who is doing poorly?

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