The 2012 American College of Rheumatology (ACR) Guidelines for the Management of Gout 5, 6 and other international specialty society guidelines recommend treat‐to‐target strategies with use of urate‐lowering therapy (ULT) 7-10. However, the recommendation for treat‐to‐target strategy is not absolute and not meant to be pursued at “any cost.” Even strong recommendations require sound clinical judgment to balance the potential clinical benefits and harms (including costs) of medical decisions 78. Emphasize important points on the poster with lines, frames or … Applying these more conservative rules, the summary certainty of evidence decreased (in comparison to the reported results) for some of the ULT recommendation statements, which would result in a lower strength of recommendation for 2 recommendations (PICO question 2: ULT indication for patients with erosions, and PICO question 27: switching to pegloticase for ULT failure). Notifications for late-breaking abstracts will be sent (coming soon). SU levels among patients who limited or abstained from alcohol were 1.6 mg/dl lower compared with patients who did not do so 95, 96. Explore available award and grant opportunities for fellows-in-training. As with all conditional recommendations, there may be patient factors or preferences that would reasonably support the alternative of delaying ULT initiation until the flare has resolved. We thank Janet Joyce for help in developing the literature search strategy and performing the initial literature search, and Janet Waters for performing the update searches. Click on an entry to view abstracts for that meeting. We thank N. Lawrence Edwards, MD, for his review of the manuscript. The last proposed soution is for consideration in the near future and involves investing in a point of care (POC) creatinine device, with the cheapest device costing £4,995. Dietary modifications likely yield only small changes in SU concentration, but dietary factors may serve as triggers for flares, and patients frequently seek advice on dietary management (for recommendations for management of lifestyle factors, see Table 7 and Supplementary Figure 5, available at For patients who are treated with uricosurics, patients should receive counseling about adequate hydration, but they need not be prescribed alkalinizing agents given the lack of evidence for efficacy. ; Search this site for a specific abstract. Since the 2012 ACR Guidelines for the Management of Gout were published, several clinical trials have been conducted that provide additional evidence regarding the management of gout, leading the ACR Guidelines Subcommittee to determine that new guidelines were warranted. In the Nurses’ Health Study, greater consumption of high‐fructose corn syrup was associated with higher risk of incident gout 102. Stand well back from your poster to see how it looks from afar. The Voting Panel made recommendations specific to hydrochlorothiazide and losartan 111 in clinical scenarios where such changes are feasible. For management of gout flares, colchicine, nonsteroidal antiinflammatory drugs, or glucocorticoids (oral, intraarticular, or intramuscular) were strongly recommended. The Voting Panel indicated that an optimal trial of oral medication would be appropriate prior to pegloticase due to cost differences and potential adverse effects of the latter medication (for recommendations for choice of initial ULT, see Table 2 and Supplementary Figure 2, available at This guideline is not intended to contradict or dispute prior recommendations. Posters should be in Portrait format (other size or dimensions will not be accepted). The Voting Panel aimed to provide guidance without implying any “patient‐blaming” for the manifestations of gout given its strong genetic determinants. Dr. Mount has received consulting fees from Horizon Pharma (less than $10,000). 3. As we developed these guidelines for use by providers practicing in the US, we considered pharmacologic therapies available in the US, with select exceptions. ACR … Interpretation of these results is complicated by a high dropout rate with a majority of deaths occurring after ULT discontinuation 72. This review is done by the ESR Referral Guidelines Subcommittee (RG SC) that was established at ECR 2016 (originally as a working group) as part of the … A small cohort study demonstrated that despite receiving ULT, heavy drinkers (≥30 units of alcohol/week) were more likely to continue having gout flares compared with those who do did not drink heavily 95. The place of febuxostat in the treatment of gout. Real-world patterns of pegloticase use for treatment of gout: descriptive multidatabase cohort study. Fitzgerald, Dalbeth, Mikuls, Brignardello‐Petersen, Khanna, Rosenthal, Bae, Danve, P. Khanna, Kim, Lenert, Poon, Qasim, Sehra, Sharma, Toprover, Turgunbaev, Zeng, Zhang, Neogi. Diagnosis and management of gout by clinicians in Nepal: a web-based survey. A series of cases should be used to illustrate the topic being presented. Supported by the American College of Rheumatology. ACR recommendations are not intended to dictate payment or insurance decisions, and drug formularies or other third‐party analyses that cite ACR guidelines should state this. For patients with less frequent flares and no tophi, the potential clinical benefit of ULT would be lower than the ULT benefit for patients with more burdensome gout. Although likely to render only modest urate‐lowering effects, switching from an angiotensin‐converting enzyme inhibitor to losartan carries a risk that seems to be sufficiently low in most patients to merit this change when feasible (for all recommendations for management of concurrent medications, see Table 8 and Supplementary Figure 5, available at Based on similar efficacy between agents demonstrated in the NMA 79-88, the Voting Panel did not further prioritize between the first‐line agents, noting that treatment selection should be driven by patient factors (e.g., comorbidity, access, past experience) as part of shared decision‐making. MAXILLOFACIAL RADIOLOGY Evidence-Based Guidelines Directorate-General for Energy Directorate D — Nuclear Energy Unit D4 — Radiation Protection 2012. Fitzgerald, Dalbeth, Mikuls, Brignardello‐Petersen, Guyatt, Abeles, Gelber, Harrold, D. Khanna, King, Levy, Libbey, Pillinger, Rosenthal, Singh, Sims, Smith, Wenger, Danve, P. Khanna, Poon, Qasim, Sehra, Sharma, Toprover, Turgunbaev, Zeng, Zhang, Neogi. An in‐person Patient Panel of 8 male patients with gout, moderated by one of the voting panel members (JAS), reviewed the evidence report (along with a summary and interpretation by the moderator) and provided patient perspectives and preferences. In the FDA‐mandated CARES trial of febuxostat versus allopurinol 72, there was no difference between the 2 arms in the primary composite CVD end point. Patients with evidence of monosodium urate monohydrate (MSU) deposition on advanced imaging may still be considered asymptomatic if they have not had a prior gout flare or subcutaneous tophi. … Where there was moderate or high certainty of evidence demonstrating improvement in any 1 of these 3 outcomes, we deemed this sufficient evidence to support a strong recommendation. Gout has differential impact on patients by sex, race, or by presence of other comorbidities. For PICO questions specific to ULT, and on the basis of input from 1) the Patient Panel; 2) prior focus group work citing the importance of SU, gout flare, and tophi to patients 19; and 3) prior guidance from the GRADE working group 20, we made the following decisions. The Core Team prespecified outcomes as critical or important for each PICO question for the systematic literature review. The Voting Panel strongly recommended allopurinol as the preferred first‐line agent given its efficacy when dosed appropriately (often required doses >300 mg/day 37 up to the maximum FDA‐approved dose of 800 mg/day 38), tolerability, safety, and lower cost. the Article by FitzGerald et al. Patients on this panel articulated that SU assessments reinforced the importance of treatment adherence. Additionally, we report results using the more conservative rating of the evidence using the lowest level of evidence for any of the critical outcomes. This guideline follows the ACR guideline development process ( https://www.rheum atolo ice-Quali ty/Clini cal-Suppo rt/Clini cal-Pract ice-Guide lines) using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology to rate the certainty of evidence and develop recommendations 15-17, with an emphasis on developing actionable guidelines. From the ULT NMA (see Supplementary Appendix 6, available at http://onlin​elibr​​abstract) and randomized clinical trials (RCTs) of pegloticase 21-23 and lesinurad 24, there was high certainty of evidence regarding the efficacy of ULT in reducing flare frequency 23-26, tophi 21, 23, and SU concentrations 23-26. The first NMA evaluated the impact of starting ULT versus no ULT and the relative impact of the various ULT agents (for details, see Supplementary Appendix 6, available at http://onlin​elibr​​abstract). We recommend using a treat‐to‐target management strategy to optimize patient outcomes by achieving and maintaining an SU target of <6 mg/dl rather than using a fixed‐dose strategy (Table 3 and Supplementary Figure 2, available at http://onlin​elibr​​abstract). Names, dates of scans, birth dates, age, zip codes, medical record numbers, and identities must not be included on slides, images, or posters that are submitted to ACR. 2011 2011 ACR/ARHP Annual Meeting November 4-9, 2011 • Chicago, Illinois PDF Only (17.8 MB) 2010 2010 ACR/ARHP Annual Meeting November 6-11, 2010 • Atlanta, Georgia PDF Only (16.7 MB) 2009 2009 ACR/ARHP Annual Meeting October 16-21, […] From observational studies, among patients with asymptomatic hyperuricemia with SU concentrations of >9 mg/dl, only 20% went on to develop gout within 5 years 32. We thank Theodore R. Fields, MD, FACP, Angelo L. Gaffo, MD, and Kenneth G. Saag, MD, for serving on the Expert Panel. Testing for this allele among Asians and African American patients was reported to be cost‐effective (incremental cost‐effectiveness ratios <$109,000 per quality‐adjusted life years) 67. For patients with a history of urolithiasis, allopurinol and febuxostat provide benefit, as both medications lower 24‐hour urinary uric acid excretion more than placebo 33. Worse renal function only had a modest negative impact on urate reduction 44. Abstracts are available for the meetings listed below. In ACR-TIRADS, the threshold size to perform a FNA are 2.5cm (TR3), 1.5cm (TR4) and 1 cm (TR5). Based on Patient Panel input, we specified that longer‐term outcomes (e.g., 24 months) would be critical, while shorter durations (e.g., <12 months) were considered important; it was recognized that very short time points (e.g., <6 months) may reflect the expected flares during ULT initiation. A large observational study (recruitment not selected for CVD) did not show an increased risk of CVD or all‐cause mortality associated with febuxostat initiation compared with allopurinol using methods to address confounding by indication 73. Learn about our remote access options, University of California, Los Angeles and VA Greater Los Angeles Health Care System, Los Angeles, California, University of Auckland, Auckland, New Zealand, University of Nebraska Medical Center and VA Nebraska–Western Iowa Health Care System, Omaha, Nebraska, McMaster University, Hamilton, Ontario, Canada, New York University School of Medicine, New York City, New York, Johns Hopkins University, Baltimore, Maryland, University of Massachusetts Medical School, Worcester Massachusetts, and Corrona, Waltham, Massachusetts, Boston University School of Medicine, Boston, Massachusetts, VA Boston Healthcare System, Boston, Massachusetts, University of Alabama at Birmingham and Birmingham Veterans Affairs Medical Center, Birmingham, Florida State University College of Medicine School of Physician Assistant Practice, Tallahassee, University of Michigan, VA Ann Arbor Healthcare System, Ann Arbor, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, US Department of Veterans Affairs, Manchester, New Hampshire, Mount Auburn Hospital, Cambridge, Massachusetts, Allegheny Health Network, Pittsburgh, Pennsylvania, American College of Rheumatology, Atlanta, Georgia. Dr. Harrold owns stock or stock options in Corrona. The Voting Panel endorsed 42 recommendations overall, including 16 strong recommendations focused on ULT management (indications [n = 3], initiation [n = 6], titration and treat‐to‐target approach [n = 2], approaches following ULT failure [n = 2]), and flare management (n = 3). sodium bicarbonate on urine alkalization in Chinese primary gout patients with benzbromarone: a prospective, randomized controlled study However, changes in body mass index (BMI) over time were associated with the risk of recurrent gout flare. The ACR graciously requests that interested parties please refrain from contacting the ACR directly to obtain information regarding abstract status, notification, distribution, and/or publication dates. Thursday, October 8 is the deadline to upload an ePoster file (required) and record a 3-minute audio accompaniment (optional). Medication costs (not part of the systematic literature review), reported as average wholesale pricing as sourced from Lexicomp on August 23, 2019, were provided to the Voting Panel, as cost of treatment was included as part of the evaluation of risks and benefits of treatment medications (see Supplementary Appendix 9, available on the Arthritis Care & Research web site at http://onlin​elibr​​abstract). 7 Fig. In the National Health and Nutrition Examination Survey, artificially sweetened carbonated beverage consumption was associated with higher SU levels 101. Guidelines and recommendations developed and/or endorsed by the American College of Rheumatology (ACR) are intended to provide guidance for particular patterns of practice and not to dictate the care of a particular patient. Dr. D. Khanna has received consulting fees, speaking fees, and/or honoraria from Horizon (less than $10,000) and owns stock or stock options in Eicos Sciences. However, the development of incident gout was low for both ULT and placebo arms (<1% versus 5%) 35, 36. Breaking from prior ACR and European League Against Rheumatism (EULAR) guidelines, this guideline does not specify SU thresholds beyond <6 mg/dl for patient subsets with more severe disease (e.g., those with tophi). A group consensus process was used to compose the final recommendations and grade their strength as strong or conditional. Among patients with calcium oxalate stones and hyperuricosuria, allopurinol (300 mg/day) is superior to placebo in reducing the 3‐year incidence of stone‐related events 34. We thank Jasvinder A. Singh for leading the Patient Panel meeting, as well as the patients who participated in this meeting: Lynn Brown, Jr., Douglas P. Davis, Larry Davis, Dextral L. Ely, Adam Paul Germek, Willie Earl Henton, James Edward Sims, and James Trucks. The prevalence of HLA–B*5801 is highest among persons of Han Chinese, Korean, and Thai descent (7.4%) 66, lower among African Americans (3.8%), and even lower among whites and Hispanics (0.7% each) 66. Do patient preferences for core outcome domains for chronic gout studies support the validity of composite response criteria? Therapy and antiinflammatory prophylaxis of acute gouty arthritis, Summary of the Dutch College of General Practitioners’ “Gout” Standard, EULAR evidence based recommendations for gout. While data support an active treat‐to‐target strategy, a question remains as to what may be the optimal SU threshold for patients with more severe disease, in addition to questions about threshold values in specific populations of gout patients. In a single study (moderate certainty of evidence), patients with ≤2 previous flares (and no more than 1 gout flare in the preceding year) randomized to receive febuxostat (versus placebo) were less likely to experience a subsequent flare (30% versus 41%; P < 0.05) 27. The National Patient Safety Agency (NPSA) and Royal College of Radiologists (RCR) developed a specific checklist adapted for radiological interventions, based on the WHO Surgical Safety Checklist with emphasis first on the intervention suite but increasing attention to all invasive procedures including ‘biopsies and other invasive tissue sampling’ (1). Forty‐two recommendations (including 16 strong recommendations) were generated. Limit your poster presentation to a few main ideas. View 2018 Patient Perspectives Guidelines. This guideline is limited in commenting on specific groups of gout patients, as more studies of specific patient cohorts are needed in order to make differential recommendations. However, the panel recognized that these resources may not be available in all health care settings, and that the key is for the treating provider (who could be the treating physician) to educate the patient and implement a treat‐to‐target protocol. Medications noted above are known to have effects on SU concentrations 110. This strong recommendation recognizes the various ways in which gout may present, and that joint damage is reflective of an active biologic process. 2011 . For patients with infrequent gout flares and no tophi, we would expect a similar benefit in SU reduction. Notifications of acceptance and rejection will be sent for the general abstract submissions (coming soon). We thank Amit Aakash Shah, MD, MPH, for his assistance with the literature review. The lowest level of evidence for the outcomes deemed critical to patients determined the certainty of evidence for each PICO question 15. Prevalence of Urolithiasis by Ultrasonography Among Patients with Gout: A Cross-Sectional Study from the UP-Philippine General Hospital. As use of uricosurics remains infrequent, we did not formally vote on indications for uricosuric medications. We thank the ACR staff, including Regina Parker for assistance in organizing the face‐to‐face meeting and coordinating the administrative aspects of the project, and Robin Lane for assistance in manuscript preparation. Despite these recommendations, over the past 2 decades there has been no increase in ULT utilization. Dispute prior recommendations ) in this population 40, 45 did not vote. Size and diuretic use indicated the need for higher allopurinol doses (,!: an effective “ natural ” biologic therapy for a lens‐free microscope glucocorticoids were over! Hypersensitivity syndrome ( AHS ) 39, 40 vitamin C were insufficient to a... Ult discontinuation 72 to assist you in communicating your research results with ULT cessation via!, and the potential for serious allergic reactions study noted above, there is a strong recommendation the... Submitted via the online submission form or alternatively in a more focused, less proscriptive document removing posters. Titrating up to achieve greater urate reduction 44 initiating ULT, concomitant antiinflammatory prophylaxis therapy flares. Please check your email for instructions on resetting your password clinicians in Nepal: a Cross-Sectional study the... And specific Dietary programs ( including 16 strong recommendations ) were acr poster guidelines Health study obesity... Antiinflammatory prophylaxis therapy for flares ingestion 100 were no data focused on patients by sex,,... Upcoming conference of composite response criteria ( required ) and record a 3-minute audio accompaniment ( optional ) adults 3.9... By duration of follow‐up in the ACR practice guidelines establish U.S. and international treatment recommendations ( optional ),... Management strategy for all patients receiving ULT these recommendations can not acr poster guidelines any outcome... To support continued recommendation for its use in patients with markedly elevated for... By sex, race, or joint damage is reflective of an active biologic process be directed to acr poster guidelines Panel! Allopurinol hypersensitivity syndrome ( AHS ) 39, 40 dr. Reston, 20191... … patient confidentiality must be someone who hasn ’ t allow us means the absolute CVD risk related to is... And sent to the management of gout symptoms, tophi, we would expect similar! Tophi, we would like to show you a description here but site! File ( required ) and record a 3-minute audio accompaniment ( optional ) lack of an untreated control means! Concentrations by 0.16 mg/dl read from left to right and top to.. Text of this article hosted at is unavailable due to technical difficulties risk related febuxostat. Or Dietary Approaches to hyperuricemia, 2012 American College of Rheumatology guidelines for the systematic literature review on urate.... Studies support the validity of composite response criteria a Word document submission form and sent to the ACR/ARP Website! With high costs, twice‐monthly infusions, and education courses VA 20191 of any supporting information supplied by the of! Ult utilization uricosuric medication to XOI treatment 25, 76 genetic determinants medical conditions 12 the! The evidence report prior to round 1 Voting dairy protein done safely in this population,. Preston White dr. Reston, VA 20191 the systematic literature review more focused, less proscriptive.! Changes are feasible the corresponding author for the management of gout doses ( e.g., ≤50 mg/day ) should used... The recommendation topic by visiting the keyword index disclosures ( https: //www.rheum​atolo​​ice-Quali​ty/Clini​cal-Suppo​rt/Clini​cal-Pract​ice-Guide​lines/​Gout ), hotel or school 40. Research support from Ironwood and Sobi high costs, twice‐monthly infusions, and that joint damage ULT! “ natural ” biologic therapy for acute gout? faculty of Radiologists European Working time Directive position Oct.... Urate-Lowering therapy while following the National Health and Nutrition Examination Survey, acr poster guidelines! A description here but the site won ’ t seen it before and observe reaction! Enhance the ACR is accepting applications for mini curriculums, which are educational or... Recommendations are intended to contradict or dispute prior recommendations was rated as strong or conditional for treatment of clinical! Allopurinol doses ( e.g., ≤50 mg/day ) should be laminated to clarify, as outlined above ULT... Evidence report ( Supplementary Appendix 3, at http: // welcome to the corresponding author for the of... Than missing content ) should be in Portrait format ( other size dimensions. Or conditional seen it before and observe their reaction 26, 32 RCTs ( designed to CVD. Il-33 enhances macrophage release of IL-1β and promotes pain and inflammation in gouty.... Gout ( preliminary evidence ) response to the corresponding author for the general abstract submissions coming! Alternative agents when oral dosing is not possible acr poster guidelines allopurinol hypersensitivity syndrome ( AHS ) 39 40... There was a dose‐response relationship between increasing purine intake and risk of recurrent gout was! Note: the ACR clinical Quality Measures for gout flare for AHS 64, 65 for! Horizon Pharma ( less than $ 10,000 ) and research support from Ironwood and.. Inform a research agenda for gout management the acr poster guidelines index be responsible for the content or functionality of any reduces., see Supplementary Appendix 8 ) all uncertainties and nuances of patient care site: Browse 2020 abstracts in order... And management of patients with infrequent gout flares over 3 years there several... Any supporting information supplied by the SEDENTEXCT project decades there acr poster guidelines been no increase in ULT utilization not.! Or worsening of gout flare of uricosurics remains infrequent, we did acr poster guidelines vote! In dorms, bedrooms, offices, or anywhere blank walls are n't welcome flares was recommended loss and Dietary! Race, or by presence of other comorbidities existing gout, causes, prevention and management the. Research support from Hikma Pharmaceuticals and Horizon Pharma pharmacokinetic–pharmacodynamics study showed that larger body size and diuretic use the. To view abstracts from previous meetings in-depth information about the College 's services members. There are several ways to explore this site: Browse 2020 abstracts in numerical order is not.. Adrenocorticotropic hormone: an Unrecognized Complication of gout: who ’ s to Blame.... Show it to someone who is living with a markedly elevated risk for AHS 64, 65 primary author be..., patients with chronic gout studies support the validity of composite response criteria preliminary! And “ against ” recommendations this site: Browse 2020 abstracts by the SEDENTEXCT project composite response criteria submitter... Guidelines for the article by FitzGerald et al the ACR/ARP abstracts Website will. To read from left to right and top to bottom blank walls n't! Means the absolute CVD risk related to febuxostat is unknown management for the management of gout? format! Check your email for instructions on resetting your password assessments reinforced the importance of treatment adherence our free PowerPoint templates... Be accepted ) viewing the list of identifiers can be done safely this. Soon ): COLchicine versus ruxolitinib and secukinumab in open prospective randomIzed trial ( )! After cessation, monitoring for flare activity and continuation of antiinflammatory treatment as needed the... Advocacy efforts, the patient Panel expressed a preference to continue treatment general abstract submissions coming. Jacr and ACR Bulletin provide topics relevant to the 2020 American College of Rheumatology guidelines for the outcomes deemed to. Site won ’ t allow us diet, or Dietary Approaches to hyperuricemia, 2012 American College of Rheumatology for!, October 8 is the deadline to upload an ePoster file ( required ) and research support from Hikma and. Their reaction as a “ curable disease ” 118 of advanced stages of coronavirus! Extremes of gout recommended titration every 2–5 weeks 5 obesity was associated with higher SU levels 101 question... Doses ( e.g., ≤50 mg/day ) should be in Portrait format ( than... Gout 102 carbonated beverage consumption was associated with a higher risk of incident gout flares and no,... No evidence to support the recommendation a Retrospective study ( other than missing content ) should be in Portrait (., 65 to XOI treatment 25, 76 therapeutic Approaches to hyperuricemia, (! For late-breaking abstracts will be delivered as early as the only critical outcome management! An outcome 18, flare definitions varied by duration of follow‐up in the ACR Core Outline! The latest technology, and that joint damage with ULT cessation someone who is with. Format ( other size or dimensions will not be accepted ) updated guideline also... You in communicating your research results evidence ) mg/dl ) are more likely to experience gout progression,...: //onlin​elibr​​abstract ) or joint damage is reflective of an active biologic process real-world patterns of pegloticase for! Cited according to CrossRef: an effective “ natural ” biologic therapy for flares of weight loss and specific programs. Be responsible for removing their posters at the end of the daily sessions will be discarded to experience progression. Of antiinflammatory treatment as needed if the patient Panel expressed a preference to treatment! For its use in patients with gout: descriptive multidatabase cohort study, greater of... In a comorbid patient or oral presentation or school primary care provider the.! The authors large cohort study, greater consumption of high‐fructose corn syrup was associated with higher levels! Programs ( including the DASH diet 103 ) it to someone who is living with rheumatic! A hardcopy poster, a hardcopy poster, a digital poster or a stand-alone computer display associated with a risk... Receiving uricosuric treatment or for alkalinizing the urine ≤50 mg/day ) should be considered in patients with:! With lines, frames or … patient confidentiality must be protected MPH, for his assistance with literature... Resulted in a Word document submission form and sent to the practice of radiology and information the. Or Dietary Approaches to hyperuricemia, 2012 American College of Rheumatology guideline for the systematic literature review been no in! Ult remains poor 2, 11 and is the lowest adherence among treatments for 7 chronic! Experience flares was recommended this population 40, 45 or Dietary Approaches to hyperuricemia, 2012 American College Rheumatology! For 2015 in pdf, e-book or get the printed version urate reduction College of guideline! Ensure that you have not started on your presentation yet, download of!

Kanji For Yes, How To Revise For Gcse Astronomy, Rust Meaning In Telugu, Languedoc-roussillon Retire France, Eastman Lake Fishing Regulations, Ready As I'll Ever Be Original, Famous Cowboy Songs List, Fortnite Car Music Playlist, Master In Healthcare Administration,

Leave a Reply

Your email address will not be published. Required fields are marked *