In terms of weight loss as a management strategy, the available evidence is in favor of weight loss for overweight/obese gout patients. For management of gout flares, colchicine, nonsteroidal antiinflammatory drugs, or glucocorticoids (oral, intraarticular, or intramuscular) were strongly recommended. The aim of this group, consisting of rheumatologists particularly interested in the subject, is to promote the development of projects about crystal arthritis. 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Recommendation 63: There are no robust studies on the safety or possible pharmacokinetic interactions of different combinations of urate-lowering drugs. Recommendation 44: Primary care patients with gout and hypertension should be assessed for suspension of thiazide and loop diuretics and initiation of treatment with angiotensin receptor antagonists (especially losartan) or calcium channel blockers (LE 5; GR D). 20. Prophylaxis for Recurrence of Acute Inflammation Attacks. 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. Recommendation 43: In primary care patients with gout and indication of cardiovascular events prevention administration of low-dose aspirin should not be suspended (LE 5; GR D). For international distribution, the guidelines will be translated into English in order to include it in the National Guideline Clearinghouse. The contents of this Clinical Practice Guideline may be used and reproduced without special permission so long as the source is credited. Recommendation 50: Currently it is not possible to recommend one urate-lowering drug over another (LE 5; GR D). The most frequent contraindications associated with pharmacologic treatment of gout are summarized in Table 25 in the original guideline document. However, since the current evidence consists of only a … [90 references] PubMed, The type of supporting evidence is identified and graded for each recommendation (see the "Major Recommendations" field.). Accessed on Dec. 15, 2016.. Khanna D, Fitzgerald JD, Khanna PP, Bae S, Singh MK, Neogi T, et al; American College of Rheumatology. Recommendation 27: In haemodialysis patients who require prophylaxis of acute episodes it would be advisable to use high permeability membranes and to prescribe a dose of 0.5–0.6 mg of colchicine after dialysis, but it must be noted that this is not approved in the current SmPC (LE 4; GR C). Chart Documentation/Checklists/Forms Foreign Language Translations Patient Resources Quick Reference Guides/Physician Guides. 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). These guidelines are provided only as assistance for physicians making clinical decisions regarding the care of their patients. COOPERATING BODIES The Spanish Society of Rheumatology (SER) is a nonprofit organization that acts as a sponsor of these clinical practice guidelines (CPG), having previously established the need for its … 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. 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. Once the final text of the clinical practice guideline (CPG) was written, it was decided to publish it in PDF and HTML format on the website of the Spanish Rheumatology Society (SER). Recommendation 46: The treatment goal is the dissolution of MSU crystals by reducing serum urate levels (LE 5; GR D). 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) or cytochrome P450 (CYP)3A4 inhibitors (protease inhibitors, macrolides, antifungals, etc.). Recommendation 3: In cases of arthritis of unknown origin gout should be included in the differential diagnosis (LE 5; GR D). Recommendation 30: Allopurinol should be administered after haemodialysis (LE 2a; GR B). 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. Management of Acute and Recurrent Gout: A Clinical Practice Guideline from the American College of Physicians (2016) Full text. This is the current release of the guideline. Recommendation 61: The early use of low-dose colchicine is effective in controlling acute gout attacks and so it should be considered in these cases (LE 1b; GR A). Recommendation 21: In patients with CKD and gout the use of colchicine for prophylaxis of new attacks can be assessed using the SmPC (LE 2b; GR B). Recommendation 51: The selection of the urate-lowering drug will be based on data regarding efficacy, safety and experience of the prescribing physician, the patient's clinical profile – severity of illness and comorbidity – and indications, recommendations and restrictions described in each product's SmPC (LE 5; GR D). Recommendation 17: In patients with CKD, consider discontinuing statins while using colchicine (LE 3a; GR B). Benzbromarone use is contraindicated in patients with hyperuricaemia due to hyperproduction (normal urate clearance) or a history of urolithiasis. Match season is complex—especially this year. As with all clinical reference resources, they reflect the best understanding of the science of medicine at the time of publication, but they should be used with the clear understanding that continued research may result in new knowledge and recommendations. 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. Intercritical Period: First Assessment after an Acute Episode. This clinical practice guideline (CPG), sponsored by the Spanish Rheumatology Society (SER), was funded by Menarini laboratories. Limiting intake of foods high in purines, such as red meat, organ meats and seafood. For grading the level of evidence, the levels of the Oxford Centre of Evidence-Based Medicine were used. Clinical practice 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). Guidelines represented on the NGC Web site are submitted by guideline developers, and are screened solely to determine that they meet the NGC Inclusion Criteria which may be found at http://www.guideline.gov/about/inclusion-criteria.aspx. B. c. Monosodium urate (MSU) … Recommendation 62: It is generally not advisable to combine two urate-lowering drugs with the same mechanism of action (LE 5; GR D). Use low-dose colchicine (1.2 mg, then 0.6 mg 1 hr later) when using colchicine for acute gout. The contract signed between the Spanish Rheumatology Foundation (FER), the SER Research Unit (RU) staff employment agency and coordinator of RU payments to panelists and reviewers as the sole intermediary, and the pharmaceutical company, provided the total independence of the participants regarding the funding source. Please visit our privacy policy page for more information. 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). However, making certain lifestyle changes also are important, such as: 1. All rights reserved. Recommendation 35: In patients with kidney transplant, corticotropin is a potential therapeutic alternative for the treatment of acute attacks (LE 4; GR C). Recommendation 64: The AEMPS withdrew the authorization of drugs with allopurinol benzbromarone in a fixed dose combination for safety reasons. 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). Also, there have been reports of DRESS syndrome (Drug Rash with Eosinophilia and Systemic Symptoms) associated with the use of allopurinol, and in addition to the rash fever, elevated acute phase reactants with eosinophilia, abnormal liver enzymes and renal function impairment. NSAIDs are also contraindicated in patients with ulcers or active gastrointestinal bleeding. Unlimited Access to Thousands of Summaries, Personalized Content Recommendations and Alerts, Access Saved Content on All Mobile Devices. This group consists of rheumatologists trained and experienced in systematic reviews, whose main interest is the dissemination of these tools among the group of Spanish rheumatologists. Cochrane Database Syst Rev. The Philippine Rheumatology Association had produced two guidelines in 2008. CLINICAL PRACTICE GUIDELINES OCTOBER 2008 MOH/P/PAK/172.08 (GU) 8. A discussion of the benefits, harms, costs, and individual preferences should be held with patients who have recurrent gout attacks before initiating urate-lowering therapy and concomitant prophylaxis. Gout is the most common cause of inflammatory arthritis worldwide. We would like to show you a description here but the site won’t allow us. Possible drug interactions are shown in Table 26 in the original guideline document. In a Cochrane review (2 trials, 124 participants) 15 high and low dose colchicine reduced the pain of acute gout, but higher doses were associated with more … Rather we urge patients and their representatives to review this material and then to consult with a licensed health professional for evaluation of treatment options suitable for them as well as for diagnosis and answers to their personal medical questions. It is estimated that approximately 2% of patients have a hypersensitivity reaction to this drug. – US Government Rights. In this group high-dose corticosteroids are contraindicated. They can be administered either by intraarticular injection in the case of monoarthritis, or systemically in cases with more extensive joint involvement (LE 2b; GR B). Recommendation 33: If it is necessary to use colchicine in patients with kidney transplant and cyclosporine A, it is recommended to reduce the dose of colchicine to one-third in acute episodes and to one-fourth in prophylaxis (LE 2b; GR B). Recommendation 12: The panel recommends to evaluate in patients with gout the magnitude of the attack and severity of the disease (LE 5; GR D). http://www.guideline.gov/about/inclusion-criteria.aspx. Recommendation 57: The use of NSAIDs or corticosteroids to prevent acute episodes of inflammation in asymptomatic patients may be considered under conditions other than those approved by the Spanish Agency of Medicines and Medical Devices (AEMPS) (LE 5; GR D). This classification allows calculating the strength of the recommendations and evaluating the quality of evidence based on the best design to answer the question (see Table 2 in the original guideline document). Specifically, … Adding a Uricosuric Agent to a Xanthine Oxidase Inhibitor. 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. Please note: This patient information is intended to provide health professionals with information to share with their patients to help them better understand their health and their diagnosed disorders. 24. 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. 2000;(4):CD002296. 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 … For this evaluation the Delphi method (two rounds) was used through anonymous online surveys as well as a physical meeting. Recommendation 56: Evaluation of response to urate-lowering treatment may be made based on a number of variables, including: frequency of acute attacks, serum uric acid levels, presence and number of MSU crystals in synovial fluid, and number and size of tophi (LE 5; GR D). Clinically significant adverse effects are rare with febuxostat, the most common being elevated liver enzymes. Thank you for being a user of Guideline Central! Recommendation 66: Canakinumab, rilonacept and anakinra may be effective in the treatment and prevention of acute episodes of inflammation. 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). 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 … Although most of them are mild exanthematous skin reactions, more severe forms have also been reported and even some with fatal outcome. Gout. Another objective of this meeting was to quantify the level of agreement and consensus among experts. Rostom A, Wells G, Tugwell P, Welch V, Dube C, McGowan J. 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