2020 American College of Rheumatology Guideline for the Management of Gout.
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FitzGerald John D, Dalbeth Nicola, Mikuls Ted, Brignardello-Petersen Romina, Guyatt Gordon, Abeles Aryeh M, Gelber Allan C, Harrold Leslie R, Khanna Dinesh, King Charles, Levy Gerald, Libbey Caryn, Mount David, Pillinger Michael H, Rosenthal Ann, Singh Jasvinder A, Sims James Edward, Smith Benjamin J, Wenger Neil S, Bae Sangmee Sharon, Danve Abhijeet, Khanna Puja P, Kim Seoyoung C, Lenert Aleksander, Poon Samuel, Qasim Anila, Sehra Shiv T, Sharma Tarun Sudhir Kumar, Toprover Michael, Turgunbaev Marat, Zeng Linan, Zhang Mary Ann, Turner Amy S, Neogi Tuhina
Аннотация
METHODS: Fifty-seven population, intervention, comparator, and outcomes questions were developed, followed by a systematic literature review, including network meta-analyses with ratings of the available evidence according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology, and patient input. A group consensus process was used to compose the final recommendations and grade their strength as strong or conditional.
RESULTS: Forty-two recommendations (including 16 strong recommendations) were generated. Strong recommendations included initiation of ULT for all patients with tophaceous gout, radiographic damage due to gout, or frequent gout flares; allopurinol as the preferred first-line ULT, including for those with moderate-to-severe chronic kidney disease (CKD; stage >3); using a low starting dose of allopurinol (≤100 mg/day, and lower in CKD) or febuxostat (<40 mg/day); and a treat-to-target management strategy with ULT dose titration guided by serial serum urate (SU) measurements, with an SU target of <6 mg/dl. When initiating ULT, concomitant antiinflammatory prophylaxis therapy for a duration of at least 3-6 months was strongly recommended. For management of gout flares, colchicine, nonsteroidal antiinflammatory drugs, or glucocorticoids (oral, intraarticular, or intramuscular) were strongly recommended.
CONCLUSION: Using GRADE methodology and informed by a consensus process based on evidence from the current literature and patient preferences, this guideline provides direction for clinicians and patients making decisions on the management of gout.