gout treatment
216466829
Gout treatment: problems, paradoxes, prospects
Interview with a leading expert in the treatment of gout, head of the laboratory of microcrystalline arthritis of the Federal State Budget Scientific Institution "Scientific Research Institute of Rheumatology named after V.A. Nasonova" candidate of medical sciences Maxim Sergeevich Eliseev.
Maxim S Eliseev
230525676
Controversial issues of gout treatment
M N Chikina Maxim S Eliseev
203470121
Gout Treatment Helpful Treatment Options
Gout is a relatively common condition affecting those as young as those in their 20's. There are many risk factors. This case report looks at a 40 years old man who had many acute gout attacks and what treatment options were helpful for him.
Navin Kumar Devaraj
52957242
Association of Chronic Kidney Disease With Allopurinol Use in Gout Treatment
Importance Clinicians are often cautious about use of allopurinol in patients with gout when renal function declines. Objective To assess the association of allopurinol use in gout with the risk of developing chronic kidney disease stage 3 or higher. Design, Setting, and Participants A time stratified propensity score matched, population based, prospective cohort study of individuals with newly diagnosed gout who initiated allopurinol =300 mg/d) compared with those who did not initiate allopurinol, using the Health Improvement Network (THIN) a United Kingdom general practitioner electronic health records database, was carried out. The data were analyzed using Cox proportional hazards regression. Among adults aged 18 to 89 years with newly diagnosed gout, we propensity score matched 4760 initiators of allopurinol =300 mg/d) to the same number of noninitiators of allopurinol, excluding those with chronic kidney disease stage 3 or higher or urate lowering therapy use before their gout diagnosis. Exposures Allopurinol initiation at a dose of 300 mg or more per day. Main Outcomes and Measures Development of chronic kidney disease stage 3 or higher. Results Of the 4760 allopurinol initiators (3975 men, 785 women) and same number of noninitiators (3971 men, 789 women) 579 and 623, respectively, developed chronic kidney disease stage 3 or higher, with a mean follow up time of 5 and 4 years, mean age of 57 years, and mean body mass index (calculated as weight in kilograms divided by height in meters squared) of 30 for both groups. Use of allopurinol of at least 300 mg/d was associated with lower risk of developing chronic kidney disease stage 3 or higher compared with nonusers, with a hazard ratio (HR) of 0.87 (95% CI, 0.77 0.97) Allopurinol initiation at less than 300 mg/d was not associated with renal function decline (HR, 1.00; 95% CI, 0.91 1.09) Conclusions and Relevance In this large cohort, allopurinol initiation of at least 300 mg/d was associated with a lower risk of renal function deterioration. Because allopurinol does not appear to be associated with renal function decline, clinicians should consider evaluating other potential causes when patients with gout experience renal function decline.
JAMA internal medicine
Ana Beatriz Vargas-Santos Christine E Peloquin Yuqing Zhang Tuhina Neogi
51922880
Goals of gout treatment: a patient perspective
To assess the goals of gout treatment from a patient perspective, a convenience sample of consecutive patients with doctor diagnosed gout seen at a community based outpatient clinic were invited. Sex stratified nominal groups were conducted until saturation was achieved. Responses were collected verbatim, discussed, and rank ordered by each participant. Thirty six patients with doctor diagnosed gout participated in 12 nominal groups: 6 male only, 5 female only, and 1 group with both. Mean age was 61.9 years (SD, 12.3) mean gout duration was 13.3 years (SD, 12.5) 53% were men, 64% African American, 42% retired, 47% currently married, 87% were using either allopurinol and/or febuxostat, and 40% had had no gout flares in the last 6 months. The top 5 treatment goals accounted for 91% of all votes and included the following: (1) prevent and better manage flare ups and improve function (25% (2) eliminate flare ups/disease remission (30% (3) diet and activity modification/lifestyle change (13% (4) patient education and public awareness (12% and (5) medication management and minimization of side effects (11% When examining the top rated concern for each nominal group, the first two goals were nominated by four groups each, diet/activity modification and medication management by 1 group each, and patient education by 3 groups. There were no differences evident by sex in top ranked treatment goal. People with gout identified and rank ordered treatment goals relevant to them. Providers of gout care need to be cognizant of these goals. Disease management concordant with these treatment goals might lead to a more satisfied, informed patient.
Clinical Rheumatology
Jasvinder A Singh
219692033
Global epidemiology of gout: prevalence, incidence, treatment patterns and risk factors
Gout is the most common inflammatory arthritis and occurs when hyperuricaemia, sustained elevation of serum urate levels resulting in supersaturation of body tissues with urate, leads to the formation and deposition of monosodium urate crystals in and around the joints. Recent reports of the prevalence and incidence of gout vary widely according to the population studied and methods employed but range from a prevalence of <1% to 6.8% and an incidence of 0.58 2.89 per 1,000 person years. Gout is more prevalent in men than in women, with increasing age, and in some ethnic groups. Despite rising prevalence and incidence, suboptimal management of gout continues in many countries. Typically, only a third to half of patients with gout receive urate lowering therapy, which is a definitive, curative treatment, and fewer than a half of patients adhere to treatment. Many gout risk factors exist, including obesity, dietary factors and comorbid conditions. As well as a firmly established increased risk of cardiovascular disease and chronic kidney disease in those with gout, novel associations of gout with other comorbidities have been reported, including erectile dysfunction, atrial fibrillation, obstructive sleep apnoea, osteoporosis and venous thromboembolism. Discrete patterns of comorbidity clustering in individuals with gout have been described. Increasing prevalence and incidence of obesity and comorbidities are likely to contribute substantially to the rising burden of gout. Gout is a chronic crystal deposition disorder in which sustained hyperuricaemia leads to formation and deposition of monosodium urate crystals in the joints. The prevalence and incidence of gout are increasing globally, which may be related to changes in the prevalence of gout risk factors (such as obesity) and comorbidities. Gout is a common chronic crystal deposition disorder that affects between <1% and 6.8% of the population depending upon the population studied. Both prevalence and incidence of gout seem to be rising across the globe. Management of gout continues to be poor, with fewer than one half of patients receiving definitive 'curative' urate lowering therapy. Adherence to urate lowering therapy is often poor and rates of non persistence are high. Obesity and comorbidities are important risk factors for gout and are important drivers of its rising prevalence and incidence.
Nature Reviews Rheumatology
Mats Dehlin Lennart T H Jacobsson Edward Roddy
30829437
Pegloticase in gout treatment safety issues, latest evidence and clinical considerations
Gout is a common rheumatic condition, with increasing prevalence in recent decades. The mainstay of treatment for gout is oral urate lowering therapy (ULT) typically with xanthine oxidase inhibitors (XOIs) Unfortunately, a proportion of patients have persistent gout that is refractory to ULT. Pegloticase, a recombinant pegylated uricase, has been approved by the US Food and Drug Administration for the treatment of refractory gout. However, concern has been raised regarding the risk of infusion reactions, which are now understood to be largely due to the development of antipegloticase antibodies. Discontinuation of pegloticase upon failure to lower serum urate has been shown to markedly reduce infusion reaction risk, but deprives patients of what, in many cases, is a last resort treatment. In this manuscript, we review the rationale, mechanism of action, efficacy and safety of pegloticase. Additionally, we focus on potential strategies to reduce pegloticase immunogenicity and potentially make this important agent available to a wider group of patients requiring treatment.
Therapeutic advances in drug safety
Allison Guttmann Svetlana Krasnokutsky Michael H Pillinger Adey A Berhanu
201749230
Diagnosis and treatment for hyperuricemia and gout: a systematic review of clinical practice guidelines and consensus statements
Objectives Despite the publication of hundreds of trials on gout and hyperuricemia, management of these conditions remains suboptimal. We aimed to assess the quality and consistency of guidance documents for gout and hyperuricemia. Design Systematic review and quality assessment using the appraisal of guidelines for research and evaluation (AGREE) II methodology. Data sources PubMed and EMBASE (27 October 2016) two Chinese academic databases, eight guideline databases, and Google and Google scholar (July 2017) Eligibility criteria We included the latest version of international and national/regional clinical practice guidelines and consensus statements for diagnosis and/or treatment of hyperuricemia and gout, published in English or Chinese. Data extraction and synthesis Two reviewers independently screened searched items and extracted data. Four reviewers independently scored documents using AGREE II. Recommendations from all documents were tabulated and visualised in a coloured grid. Results Twenty four guidance documents (16 clinical practice guidelines and 8 consensus statements) published between 2003 and 2017 were included. Included documents performed well in the domains of scope and purpose (median 85.4% range 66.7% 100.0% and clarity of presentation (median 79.2% range 48.6% 98.6% but unsatisfactory in applicability (median 10.9% range 0.0% 66.7% and editorial independence (median 28.1% range 0.0% 83.3% The 2017 British Society of Rheumatology guideline received the highest scores. Recommendations were concordant on the target serum uric acid level for long term control, on some indications for urate lowering therapy (ULT) and on the first line drugs for ULT and for acute attack. Substantially inconsistent recommendations were provided for many items, especially for the timing of initiation of ULT and for treatment for asymptomatic hyperuricemia. Conclusions Methodological quality needs improvement in guidance documents on gout and hyperuricemia. Evidence for certain clinical questions is lacking, despite numerous trials in this field. Promoting standard guidance development methods and synthesising high quality clinical evidence are potential approaches to reduce recommendation inconsistencies. PROSPERO registration number CRD42016046104.
BMJ Open
Qianrui Li Xiaodan Li Jing Wang Hongdie Liu Joey Sum-Wing Kwong Hao Chen Ling Li Sheng-Chia Chung Anoop Dinesh Shah Yaolong Chen Zhenmei An Xin Sun Harry Hemingway Haoming Tian Sheyu Li
58650162
Anakinra for the treatment of acute gout flares: a randomized, double blind, placebo controlled, active comparator, non inferiority trial.
Objectives To evaluate the efficacy and safety of anakinra in treating acute gout flares in a randomized, double blind, placebo controlled, active comparator, non inferiority (NI) trial. Methods Patients with a crystal proven acute gout flare were randomized (1: 1) to treatment with anakinra or treatment as usual (free choice: either colchicine, naproxen or prednisone) The primary end point was the change in pain between baseline and the averaged pain score on days 2 4 measured on a five point rating scale. NI of anakinra would be established if the upper bound of the 95% CI of the numeric difference in changed pain scores between treatment groups did not exceed the NI limit of 0.4 in favour of treatment as usual, in the per protocol (PP) and intention to treat (ITT) populations, assessed in an analysis of covariance model. Secondary outcomes included safety assessments, improvement in pain, swelling, tenderness and treatment response after 5 days, assessed using linear mixed models and binary logistic regression models. Results Forty three patients received anakinra and 45 treatment as usual. Anakinra was non inferior (mean difference; 95% CI) to treatment as usual in both the PP 0.13; 0.44, 0.18) and ITT 0.18; 0.44, 0.08) populations. No unexpected or uncommon (serious) adverse events were observed in either treatment arm. Analyses of secondary outcomes showed that patients in both groups reported similar significant reductions in their gout symptoms. Conclusion Efficacy of anakinra was shown to be non inferior to treatment as usual for the treatment of acute gout flares, suggesting that anakinra is an effective treatment alternative for acute gout flares. Trial registration Het Nederlands Trial Register, www.trialregister.nl, NTR5234.
Rheumatology
Carly A Janssen Martijn A H Oude Voshaar Harald E Vonkeman Tim L Jansen Matthijs Janssen Marc R Kok Beata J Radovits Caroline van Durme Hetty Baan Mart Afj van de Laar
38360273
Physician Adherence to ACR Gout Treatment Guidelines: Perception Versus Practice
Abstract Background: In October 2012, the American College of Rheumatology (ACR) published recommendations for chronic gout treatment goals and pharmacotherapy. Objectives: Identify potential gaps between real world chronic gout treatment, ACR guideline recommendations, and physicians' perceived guideline adherence by evaluating records of patients classified as having "higher" and "lower" guideline adherence as defined by the investigators. Methods: A comprehensive quantitative survey was administered between February 11 and February 22, 2013, to physicians treating patients with gout; the survey included a patient record chart review informed by prior qualitative interviews. Eight criteria from the ACR gout management guidelines were used to compose the survey. To assess ACR guideline adherence, information from records of patients with chronic gout treated by primary care physicians (PCPs) and rheumatologists was scored from 0 (no adherence) to 8 (total adherence) in accordance with ACR guideline recommendations. Physicians also indicated how closely they believed patient treatment followed current guidelines on a 10 point scale. Results: Of the 350 records of patients with chronic gout, all but 3 PCP patients were adherent on 1 guideline recommendation, but nearly all patients could be considered nonadherent, considering all potential recommendations. Patients with chronic gout treated by rheumatologists tended to be managed more closely to ACR guidelines than patients treated by PCPs (mean scores: rheumatologists 5.8/8 1.7 vs 4.3/8 1.7 for PCPs) Among patients classified as having "higher adherence" based on adherence scores, there was low adherence on first line urate lowering therapy dose, acute prophylaxis dosing, and length of prophylaxis treatment. Among PCPs and rheumatologists, there was a disparity between how closely physicians believed patient treatment followed guidelines and actual adherence with ACR guidelines based on adherence scores. For 16.4% of patients treated by PCPs and 18.4% of patients seen by rheumatologists, physicians believed they closely followed ACR guidelines (score of 8 10/10) for each patient; but in actuality, adherence was lower. Conclusion: Although adherence with ACR guidelines is higher among rheumatologists than PCPs in treating patients with gout, overall adherence could be improved by both specialties.
Postgraduate medicine
Gary Oderda Aki Shiozawa Michael Walsh K Hess Diana I Brixner Michael Feehan Kasem S Akhras