Recommendation 8: Ultrasound-guided puncture facilitates obtaining fluid or other samples for the diagnosis of gout (LE 4; GR C). The information was verified by the guideline developer on July 22, 2014. The latter systematic review included 154 articles published through March 1, 2016. Conclusion: … Recommendation 60: In acute gout attacks corticosteroids are recommended for patients with contraindications to NSAIDs/COXIBs. Gout is the most common cause of inflammatory arthritis worldwide. To be effective, the guidelines must be implemented. Inclusion of GuipClinGot in GuíaSalud, the CGP portal of the Quality Department of the Ministry of Health was requested and it was presented to the Spanish rheumatologists at the 2012 National Congress. Recommendation 32: In renal transplant patients, concomitant administration of azathioprine and allopurinol reduces the metabolism of azathioprine and increases the risk of bone marrow toxicity, so their association is contraindicated (LE 2b; GR B). The literature search was conducted in November 2011 in the following databases: MEDLINE, EMBASE, and Cochrane Central. When we collect your data through site visits and account creation, we agree to never sell that information to third-parties. Moreover, the views and opinions of developers or authors of guidelines represented on this site do not necessarily state or reflect those of NGC, AHRQ, or its contractor ECRI Institute, and inclusion or hosting of guidelines in NGC may not be used for advertising or commercial endorsement purposes. In this group high-dose corticosteroids are contraindicated. CLINICAL PRACTICE GUIDELINES OCTOBER 2008 MOH/P/PAK/172.08 (GU) 8. Imaging Tests for Monitoring Treatment Response. Systematic reviews were conducted by members of the Spanish Society of Rheumatology (SER) Evidence-based Rheumatology group. After the meeting of the nominal group, panelists began writing their chapters and the corresponding recommendations, taking into account that the aim of these was to provide practical and specific advice on the different topics of these guidelines. With FMX On Demand, you can access recorded FMX sessions led by family medicine experts, and earn up to 155 enduring CME credits. In UK general practice, the overall prevalence has increased from 1.4% in 1999 to 2.49% in 2012 [], despite the availability of effective and potentially curative urate-lowering drugs for >50 years and evidence-based British and European management … Medications are often the most effective way to treat acute gout and can prevent recurrent attacks of gout. A major limitation of non-steroidal anti-inflammatory drugs (NSAIDs) is gastrointestinal toxicity. For management of gout flares, colchicine, nonsteroidal antiinflammatory drugs, or glucocorticoids (oral, intraarticular, or intramuscular) were strongly recommended. This clinical practice guideline (CPG), sponsored by the Spanish Rheumatology Society (SER), was funded by Menarini laboratories. Recommendation 25: Patients with CKD should be evaluated for the use of febuxostat, since it has been shown to be superior to allopurinol in all strata of mild/moderate CKD, even at doses of 40 mg/day, with a similar frequency of adverse effects (LE 1b; GR A). [90 references] PubMed, The type of supporting evidence is identified and graded for each recommendation (see the "Major Recommendations" field.). Recommendation 58: NSAIDs are effective in acute gout attacks. Recommendation 38: The education program for patients with gout (individual or group) will address the following key issues: therapeutic target, diet and alcohol consumption, pain management, cardiovascular risk management, weight control, exercise, and information about the treatments prescribed in order to improve adherence and patient safety (LE 5; GR … Spanish Society of Rheumatology (SER). Management of Gout, CPG 2008, MOH Malaysia 20. However, making certain lifestyle changes also are important, such as: 1. Algorithm for the Management of Gout . Recommendation 67: Rasburicase may be an alternative for off-label use in patients unresponsive or intolerant to all approved urate-lowering compounds. The meeting included a theoretical presentation of the working methodology of the CPG, and the floor was opened for discussion to define the scope, objectives and users of the guidelines. Recommendation 68: Ultrasound measurement of the size of MSU tophaceous deposits could be used as an outcome measure in evaluating the response to treatment of gout (LE 3a; GR B). Additional reading. Rostom A, Wells G, Tugwell P, Welch V, Dube C, McGowan J. Recommendation 59: In acute gout attacks selective inhibitors of cyclo-oxygenase-2 (COXIBs) can be considered an alternative to traditional NSAIDs in patients with high or medium gastrointestinal risk, administered with or without proton pump inhibitors (PPI), depending on the type of patient (LE 2a; GR B) (Rostom et al., 2000). The methodology used is suitable for the development of training recommendations and includes expert nominal groups, Delphi surveys and systematic reviews of the literature. In Spain the colchicine summary of product characteristics (SmPC) expressly contraindicates its prescription in patients with glomerular filtration rate (GFR) less than 30 mL/min. Recommendation 16: In patients with chronic kidney disease (CKD), the use of oral colchicine can be assessed to reduce the severity of an acute attack, following Summary of Product Characteristics (SmPC) specifications (LE 1b; GR A). Initiating ULT in patients with radiographic damage, using any modality, that is attributable to gout; Use low-dose colchicine (1.2 mg, then 0.6 mg 1 hr later) when using colchicine for acute gout. Recommendation 52: It is advisable to begin urate-lowering treatment in patients who have not achieved the therapeutic goal of uric acid (<6 mg/dL) with dietary health measures (LE 5; GR D). Febuxostat is not recommended in patients with ischaemic heart disease or congestive heart failure until there is more data on long-term cardiovascular safety from ongoing trials, as well as in patients with stage 4 (GFR <30 mL/min ) or stage 5 (GFR <10 mL/min, kidney transplant or dialysis) chronic kidney disease, due to lack of experience. The use of urate-lowering therapy for preventing deposition of monosodium urate (MSU) may limit both treatment with uricosurics due to their theoretical lithiasis promoting effect or toxicity, as well as uricostatics such as allopurinol whose recommended doses in patients with CKD impede reaching target uric acid levels. Specifically, … Recommendation 63: There are no robust studies on the safety or possible pharmacokinetic interactions of different combinations of urate-lowering drugs. In addition to accepting the invitation to participate, the following criteria for selecting panelists were used: The tasks to be performed by the panelists were: Establishment of Definitions, Scope and Tasks. Virtually none of the first-line drugs for treatment of gout is free of contraindications or significant limitations for use in patients with kidney failure. Colchicine. For grading the level of evidence, the levels of the Oxford Centre of Evidence-Based Medicine were used. Recommendation 45: Lifestyle changes should be suggested if drug treatment is prescribed to reduce serum uric acid levels after diagnosis of gout, but taking into account patient characteristics and comorbidities (LE 5; GR D). Intercritical Period: First Assessment after an Acute Episode. NSAIDs are also contraindicated in patients with ulcers or active gastrointestinal bleeding. As such, they cannot substitute the individual judgment brought to each clinical situation by the patient’s family physician. These guidelines are provided only as assistance for physicians making clinical decisions regarding the care of their patients. In terms of weight loss as a management strategy, the available evidence is in favor of weight loss for overweight/obese gout patients. Recommendation 11: Special attention should be paid to cardiovascular risk factors, using any of the available risk estimation tools (LE 5; GR D). 2. Date: Guideline Title CPG QR TM PIL: 2017: Management of Periodontal Abscess (2nd Edition) 8.95 MB 2016: Management of Acute Orofacial Infection of Odontogenic Origin in Children (1st Edition) All rights reserved. In acute gout, low-dose colchicine (1.2 mg followed by 0.6 mg in 1 hour) is as effective as high-dose colchicine (1.2 mg followed by 0.6 mg every hour for 6 hours) with fewer adverse effects. Unlimited Access to Thousands of Summaries, Personalized Content Recommendations and Alerts, Access Saved Content on All Mobile Devices. or cytochrome P450 (CYP)3A4 inhibitors (protease inhibitors, macrolides, antifungals, etc.). Recommendation 17: In patients with CKD, consider discontinuing statins while using colchicine (LE 3a; GR B). Learn About the AAFP Criteria for Endorsement of Clinical Practice Guidelines Developed by External Organizations. Madrid (Spain): Spanish Society of Rheumatology; 2013. A documentation specialist and a coordinator reviewed all the search strategies so that the terms used for the selection of the population, intervention and outcomes would be homogeneous among the different reviews to be performed, and facilitate the documents selected for review. This personal information is used solely to provide you a more personalized experience when using the Guideline Central website and app. 25. Also, there was a quick guide (with the most relevant information, from the practical point of view for the physician) with the recommendations in both PDF and paper format as well as tables and/or images that can be useful. At any time, you may opt out of tracking or request account deletion. Therefore, the recommendations should be developed according to the most appropriate action for the patient, maintaining the objective of improving quality of care. For this evaluation the Delphi method (two rounds) was used through anonymous online surveys as well as a physical meeting. Recommendation 36: Benzbromarone has shown great effectiveness in kidney transplant patients, even those treated with cyclosporine A (LE 2a; GR B). Prepare for the ABFM exam with the AAFP’s Family Medicine Board Review Express Livestream, February 18-21 and get the same in-depth Board review but with all the conveniences of your home or office. Limiting alcoholic beverages and drinks sweetened with fruit sugar (fructose). External Peer Review Internal Peer Review. What are the signs and symptoms of gout? There is no cure for gout, but you can effectively treat and manage the condition with medication and self-management strategies. Prophylaxis for Recurrence of Acute Inflammation Attacks. The prescription of uricase – any of them – is contraindicated in patients with glucose-6-phosphate dehydrogenase (GPDH) or catalase deficiency due to risk of inducing haemolytic anaemia crisis. Recommendation 66: Canakinumab, rilonacept and anakinra may be effective in the treatment and prevention of acute episodes of inflammation. Recommendation 20: In patients with CKD and gout NSAIDs are not recommended for the prevention of new attacks (LE 3a; GR B). Table 1 in the original guideline document shows the type and question of the reviews conducted. Possible drug interactions are shown in Table 26 in the original guideline document. Copyright © 2020 American Academy of Family Physicians. See Table 2 in the original guideline document. Recommendation 15: Once urate-lowering treatment has been initiated, laboratory tests should be performed to verify the achievement of the therapeutic goal (serum uric acid levels <6 mg/dL), and to monitor possible comorbidities and drug toxicity (LE 5; GR D). Philippine Clinical Practice Guidelines for the Management of Gout Technical Review Committee Members: Li-Yu J1, Salido EO2, Manahan S3, Lichauco JJ4, Lorenzo JP3, Torralba KT5, Raso AA6, … Non-steroidal anti-inflammatory drug (NSAID) use is contraindicated in the control of acute attacks and preventing their recurrence because they increase the risk of acute and chronic kidney damage. Intravenous administration has been associated with potential fatal complications. The Philippine Rheumatology Association had produced two guidelines in 2008. – US Government Rights. This NGC summary was completed by ECRI Institute on July 9, 2014. In addition, the following forms are available in the original guideline document: Several patient information resources in Spanish are available from the Spanish Society of Rheumatology Web site. Recommendation 19: In case of CKD, note that corticotropin has similar indications and efficacy to corticosteroids in the treatment of acute gout attacks (LE 1b; GR A). 21. Corticosteroids, nonsteroidal anti-inflammatory drugs (NSAIDs), or low-dose colchicine should be prescribed for patients who have acute gout. Evidence Review: Diagnosis of Gout: A Systematic Review in Support of an … Madrid (Spain): Spanish Society of Rheumatology (SER); 2013. Recently, the ACP presented a clinical practice guideline for the management of gout that differs substantially from all others developed by American and international rheumatologists 7. Access a summary of the processes used by the AAFP to produce high-quality, evidence-based guidelines. Parallel to the development of systematic reviews, experts were asked to draft recommendations for the chapter. Although lower intestinal tract complications associated with NSAID use are often subclinical, they may cause serious injury including bleeding, strictures or perforations. Defining the content, scope and objectives of the guidelines, Review and synthesis of the scientific evidence, Addressing unforeseen issues that may arise during development of the CPG, Quick reference guide (Spanish). Finally, GuipClinGot will be updated approximately every 4 years, depending on the existence of new relevant information. All rights Reserved. Management of Acute and Recurrent Gout: A Clinical Practice Guideline from the American College of Physicians (2016) Full text. Recommendation 24: In patients with CKD it is recommended to adjust the dose of allopurinol according to the SmPC (LE 5; GR D). As a member, you'll receive a variety of exclusive products, programs, services, and discounts totaling more than $3,800 in member savings. Simultaneous administration of both compounds slows azathioprine metabolism and increases the risk of bone marrow toxicity, so that their association is contraindicated. Recommendation 62: It is generally not advisable to combine two urate-lowering drugs with the same mechanism of action (LE 5; GR D). The National Guideline Clearinghouse™ (NGC) does not develop, produce, approve, or endorse the guidelines represented on this site. Clinically significant adverse effects are rare with febuxostat, the most common being elevated liver enzymes. Once the panelists were selected and they agreed to participate in the project, a meeting of the nominal group took place. Recommendation 35: In patients with kidney transplant, corticotropin is a potential therapeutic alternative for the treatment of acute attacks (LE 4; GR C). In some countries, diabetes is responsible for about half of the incidental cases of kidney disease. Recommendation 48: The urate-lowering drugs available (allopurinol, febuxostat and benzbromarone) have shown to be highly effective in achieving the therapeutic goal when prescribed in adequate doses (LE 1b; GR A). One review evaluated the evidence regarding the accuracy and safety of tests used to initially diagnose gout in the primary care, urgent care, or emergency care setting. The clinical practice guideline (CPG) was assessed by two external reviewers, a rheumatologist expert in this clinical area and a methodologist who was expert at conducting clinical practice guidelines. The authors conducted systematic reviews of the questions agreed upon with the experts, following standard methodology. Recommendation 64: The AEMPS withdrew the authorization of drugs with allopurinol benzbromarone in a fixed dose combination for safety reasons. *By signing up I agree to the privacy terms listed here, Clinical practice guidelines for management of gout, References Supporting the Recommendations, Type of Evidence Supporting the Recommendations, Methods Used to Collect/Select the Evidence, Description of Methods Used to Collect/Select the Evidence, Methods Used to Assess the Quality and Strength of the Evidence, Rating Scheme for the Strength of the Evidence, Description of the Methods Used to Analyze the Evidence, Methods Used to Formulate the Recommendations, Description of Methods Used to Formulate the Recommendations, Description of Method of Guideline Validation, Composition of Group That Authored the Guideline, Financial Disclosures/Conflicts of Interest, *By signing up I agree to the privacy terms listed, Benefits/harms Of Implementing The Guideline Recommendations, Rating Scheme For The Strength Of The Recommendations, Institute Of Medicine (iom) National Healthcare Quality Report Categories. Prevention of Acute Inflammation Episodes. Currently the group consists of 25 reviewers who follow the methodology proposed by the Cochrane Collaboration. Concomitant use of colchicine is contraindicated with P-glycoprotein inhibitors (cyclosporine, tacrolimus, amiodarone, quinidine, azole antifungals, some calcium channel blockers, vinca alkaloids, erythromycin, etc.) Recommendation 29: Sevelamer, an intestinal phosphate binder used in the treatment of hyperphosphataemia associated with advanced CKD, can reduce serum uric acid levels (LE 2a; GR B). Intercritical Period: Successive Controls. Clinical Practice Guidelines On The Management Of Osteoarthritis (2nd Edition), 2014 The Launch of the Management of Osteoarthritis (Second Edition) Clinical Practice Guideline, 28th May 2014 … All guidelines summarized by NGC and hosted on our site are produced under the auspices of medical specialty societies, relevant professional associations, public or private organizations, other government agencies, health care organizations or plans, and similar entities. NGC, AHRQ, and its contractor ECRI Institute make no warranties concerning the content or clinical efficacy or effectiveness of the clinical practice guidelines and related materials represented on this site. Repeated bouts of gout can lead to gouty arthritis, a worsening form of arthritis. 2000;(4):CD002296. You can access the full manuscripts below Gout Phil CPG 2008 OA Phil CPG 2008 If you would prefer to use simplifi… Weighting According to a Rating Scheme (Scheme Given). Maximum dosage is recommended in the absence of contraindications and suspension as soon as the attack is resolved. Recommendation 30: Allopurinol should be administered after haemodialysis (LE 2a; GR B). This summar… These recommendations were compiled into a working document for all panel members to issue an opinion or clarify specific aspects. Febuxostat is contraindicated in patients receiving concomitant therapy with azathioprine or 6-mercaptopurine due to serious bone marrow toxicity risk. Benzbromarone use is contraindicated in patients with hyperuricaemia due to hyperproduction (normal urate clearance) or a history of urolithiasis. Corticotropin (Adrenocorticotropic Hormone [ACTH]). 24. Within the group of gout drugs, allopurinol is the compound that most frequently produces allergic reactions, complicating the management of gout because it is the most widely used urate-lowering treatment. Recommendation 31: In kidney transplant patients, tacrolimus, due to having a mechanism of action similar to cyclosporine, in theory could lead to interaction with NSAIDs (LE 2b; GR B). As part of our continued efforts towards protecting your privacy and personal information, we’ve made recent updates to our privacy policy. The patient information is not reviewed by NGC to establish whether or not it accurately reflects the original guideline's content. Recommendation 39: Although the gold standard for the diagnosis of gout is the visualization of crystals, in patients with typical symptoms such as intermittent arthritis with complete resolution at the first metatarsophalangeal (MTP) joint (podagra) in the presence of prior hyperuricaemia, clinical diagnosis may be a reasonable alternative for the primary care (PC) doctor up to definitive diagnosis (LE 5; GR D). Recommendation 14: Once the acute episode is overcome the patient with gout should be studied by blood and urine analysis for determination of the following parameters: complete blood count, blood chemistry panel, liver and kidney function, acute phase reactants and study of urinary uric acid clearance (LE 5; GR D). 2012 American College of Rheumatology guidelines for management of gout… Recommendation 28: The low-medium intensity doses of peritoneal dialysis (3–4 daily peritoneal fluid stays) allow extraction of 500 mg of uric acid daily (LE 3b; GR B). Therefore, this group of patients requires a particularly careful reading of the available evidence in order to achieve an appropriate balance between the benefits and risks of treatment. The chapters to be written were agreed upon, those responsible for each chapter were appointed, questions were raised regarding systematic review and a calendar of deadlines and deliveries was set. Therefore, if they are chosen, it is recommended to request authorization for their off-label prescription use (LE 4; GR C). All participants have made an explicit statement of their potential conflicts of interest. MANAGEMENT OF A PATIENT WITH UNCOMPLICATED GOUT '1977 AMERICAN COLLEGE OF RHEUMATOLOGY CRITERIA FOR ACUTE ARTHRITIS OF GOUT* A. Prophylaxis of Recurrent Episodes of Acute Inflammation. Dose reduction can be assessed after the first 2–3 days of treatment if there is clinically significant improvement (LE 5; GR D). This patient information has been derived and prepared from a guideline for health care professionals included on NGC by the authors or publishers of that original guideline. New relevant information the AEMPS withdrew the authorization of drugs with allopurinol benzbromarone a!, macrolides, antifungals, etc. ) included 27 articles published through March 1, 2016, nonsteroidal drugs. 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