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

Richette, P.; Doherty, Michael T.; Pascual, E.; Barskova, V.; Becce, F.; Casta�eda-Sanabria, J.; Coyfish, M.; Guillo, S.; Jansen, T. L.; Janssens, H.; Liot�, F.; Mallen, C.; Nuki, G.; Perez-Ruiz, F.; Pimentao, J.; Punzi, L.; Pywell, T.; So, A.; Tausche, A.K.; Uhlig, T.; Zavada, J.; Tubach, F.; ZHANG, WEIYA; Bardin, T.

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 less than 6 mg/dL (360 mmol/L) and less than 5 mg/dL (300 mmol/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.

Citation

Richette, P., Doherty, M. T., Pascual, E., Barskova, V., Becce, F., Castañeda-Sanabria, J., …Bardin, T. (2017). 2016 updated EULAR evidence-based recommendations for the management of gout. Annals of the Rheumatic Diseases, 76(1), 29-42. https://doi.org/10.1136/annrheumdis-2016-209707

• Journal Article Type: Article
• Acceptance Date: Jun 29, 2016
• Online Publication Date: Jul 25, 2016
• Publication Date: Jan 1, 2017
• Deposit Date: Apr 17, 2018
• Journal: Annals of the Rheumatic Diseases
• Print ISSN: 0003-4967
• Electronic ISSN: 1468-2060
• Publisher: BMJ Publishing Group
• Peer Reviewed: Peer Reviewed
• Volume: 76
• Issue: 1
• Pages: 29-42
• DOI: https://doi.org/10.1136/annrheumdis-2016-209707
• Public URL: https://nottingham-repository.worktribe.com/output/1124378
• Publisher URL: https://ard.bmj.com/content/76/1/29
• PMID: 27457514