Clinician Article
Management of Acute and Recurrent Gout: A Clinical Practice Guideline From the American College of Physicians.
PMID: 27802508
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Internal MedicineRelevance - 7/7
Newsworthiness - 6/7 -
Family Medicine (FM)/General Practice (GP)Relevance - 6/7
Newsworthiness - 5/7 -
General Internal Medicine-Primary Care(US)Relevance - 6/7
Newsworthiness - 5/7 -
RheumatologyRelevance - 6/7
Newsworthiness - 4/7
Abstract
DESCRIPTION: The American College of Physicians (ACP) developed this guideline to present the evidence and provide clinical recommendations on the management of gout.
METHODS: Using the ACP grading system, the committee based these recommendations on a systematic review of randomized, controlled trials; systematic reviews; and large observational studies published between January 2010 and March 2016. Clinical outcomes evaluated included pain, joint swelling and tenderness, activities of daily living, patient global assessment, recurrence, intermediate outcomes of serum urate levels, and harms.
TARGET AUDIENCE AND PATIENT POPULATION: The target audience for this guideline includes all clinicians, and the target patient population includes adults with acute or recurrent gout.
RECOMMENDATION 1: ACP recommends that clinicians choose corticosteroids, nonsteroidal anti-inflammatory drugs (NSAIDs), or colchicine to treat patients with acute gout. (Grade: strong recommendation, high-quality evidence).
RECOMMENDATION 2: ACP recommends that clinicians use low-dose colchicine when using colchicine to treat acute gout. (Grade: strong recommendation, moderate-quality evidence).
RECOMMENDATION 3: ACP recommends against initiating long-term urate-lowering therapy in most patients after a first gout attack or in patients with infrequent attacks. (Grade: strong recommendation, moderate-quality evidence).
RECOMMENDATION 4: ACP recommends that clinicians discuss benefits, harms, costs, and individual preferences with patients before initiating urate-lowering therapy, including concomitant prophylaxis, in patients with recurrent gout attacks. (Grade: strong recommendation, moderate-quality evidence).
Clinical Comments
General Internal Medicine-Primary Care(US)
Good review of available treatments for gout and costs associated with each (both monetary costs and side effect costs).
General Internal Medicine-Primary Care(US)
This article is included in a series of articles published by the American College of Physicians. The two points worth highlighting for most clinicians are: 1) the high cost of colchicine compared with NSAIDs and the lack of documented increase in pain relief for acute exacerbations; and 2) the low-quality evidence to make a decision for lifelong urate-lowering therapy and titrating that therapy based on serum urate levels. I believe these two findings may help influence changes in current practice behavior.
Internal Medicine
Impressive review article. As a hospitalist, we deal with acute gout attacks all the time. These guidelines help a lot. Cost-analysis and reviewing every intervention with the evidence base is really useful. I learned significant points after reading this. I strongly recommend this article to hospitalists.
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