2016 updated EULAR evidence-based recommendations for the management of gout.

Abstract

BACKGROUND:

New drugs and new evidence concerning the use of established treatments have become available since the publication of the first European League Against Rheumatism (EULAR) recommendations for the management of gout, in 2006. This situation has prompted a systematic review and update of the 2006 recommendations.

METHODS:

The EULAR task force consisted of 15 rheumatologists, 1 radiologist, 2 general practitioners, 1 research fellow, 2 patients and 3 experts in epidemiology/methodology from 12 European countries. A systematic review of the literature concerning all aspects of gout treatments was performed. Subsequently, recommendations were formulated by use of a Delphi consensus approach.

RESULTS:

Three overarching principles and 11 key recommendations were generated. For the treatment of flare, colchicine, non-steroidal anti-inflammatory drugs (NSAIDs), oral or intra-articular steroids or a combination are recommended. In patients with frequent flare and contraindications to colchicine, NSAIDs and corticosteroids, an interleukin-1 blocker should be considered. In addition to education and a non-pharmacological management approach, urate-lowering therapy (ULT) should be considered from the first presentation of the disease, and serum uric acid (SUA) levels should be maintained at<6 mg/dL (360 µmol/L) and <5 mg/dL (300 µmol/L) in those with severe gout. Allopurinol is recommended as first-line ULT and its dosage should be adjusted according to renal function. If the SUA target cannot be achieved with allopurinol, then febuxostat, a uricosuric or combining a xanthine oxidase inhibitor with a uricosuric should be considered. For patients with refractory gout, pegloticase is recommended.

CONCLUSIONS:

These recommendations aim to inform physicians and patients about the non-pharmacological and pharmacological treatments for gout and to provide the best strategies to achieve the predefined urate target to cure the disease.

• Authors: P Richette, M Doherty, E Pascual, V Barskova, F Becce, J Castañeda-Sanabria, M Coyfish, S Guillo, T L Jansen, H Janssens, F Lioté, C Mallen, G Nuki, F Perez-Ruiz, J Pimentao, L Punzi, T Pywell, A So, A K Tausche, T Uhlig, J Zavada, W Zhang, F Tubach, T Bardin
• Journal: Annals of the rheumatic diseases (Ann Rheum Dis) Vol. 76 Issue 1 Pg. 29-42 (Jan 2017) ISSN: 1468-2060 [Electronic] England
• PMID: 27457514 (Publication Type: Journal Article, Practice Guideline, Review, Systematic Review)
• Copyright: Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Chemical References

• Adrenal Cortex Hormones
• Anti-Inflammatory Agents, Non-Steroidal
• Gout Suppressants
• Interleukin-1
• Uric Acid

Topics

• Adrenal Cortex Hormones (therapeutic use)
• Anti-Inflammatory Agents, Non-Steroidal (therapeutic use)
• Delphi Technique
• Directive Counseling
• Evidence-Based Medicine
• Gout (blood, drug therapy, therapy)
• Gout Suppressants (therapeutic use)
• Humans
• Interleukin-1 (antagonists & inhibitors)
• Life Style
• Patient Education as Topic
• Symptom Flare Up
• Uric Acid (blood)