Monday, 16 Sep 2019

You are here

Rheumatologists are Not Always Aligned with 2012 ACR Gout Guidelines

A cross-sectional survey of 309 Brazilan rheumatologists was performed to assess their compliance with the 2012 ACR guidelines on gout. Specifically, they assess their use of colchicine, prophylaxis with urate-lowering therapy (ULT), not interrupting ULT during acute gout, targetting SUA < 6.0 mg/dl, and allopurinol dosing regiment (e.g., starting at 100 mg qd).

During acute attacks, combination therapy (NSAIDs or steroid + colchicine) was used by nearly half, followed by NSAIDs and colchicine monotherapy.  During an acute attack, ULT was withdrawn by one-third of rheumatologists. 90% always or almost always prescribe a prophylactic treatment when initiating ULT.  Only 70% considered the target serum uric acid level to be less than 6 mg/dl. Approximately 50% of rheumatologists reported starting allopurinol at doses of 100 mg daily or less and 42% reported the initial dose to be 300 mg daily in patients with normal renal function. 

Despite being "experts in gout", rheumatologist practices may not be aligned with ACR guidelines.  Gaps in education and variability of approaches to gout management suggests more education and consensus is needed.

Disclosures: 
The author has no conflicts of interest to disclose related to this subject

Add new comment

More Like This

Modifiable Risk Factors for Hyperuricemia

Choi and colleagues have shown that four modifiable risk factors (BMI, the DASH diet, alcohol use, and diuretic use) could individually account for a notable proportion of observed hyperuricemia. 

Researchers examine modifiable risk factors for hyperuricemia and how this could be prevented through risk factor modification in the general population.

Opioids Overused in Acute Gout

Opioids were commonly given to patients as a treatment for acute gout attacks, despite the availability of other effective and appropriate therapies, a retrospective study found.

Allopurinol Fails to Curtail Hypertension

Editor's note: July 1 - 5, RheumNow is running the best of the EULAR 2019 meeting. A novel trial presented at EULAR 2019 last week assessed whether the use of urate-lowering therapy (ULT) would control hypertension in those at risk; however, results of this trial were largely negative.

Hypertension is one of the many comorbidities that plagues gout patients.

Allopurinol Fails to Curtail Hypertension

A novel trial presented at EULAR 2019 last week assessed whether the use of urate-lowering therapy (ULT) would control hypertension in those at risk; however, results of this trial were largely negative.

Hypertension is one of the many comorbidities that plagues gout patients.

Updated 2018 EULAR Recommendations for the Diagnosis of Gout

The first EULAR recommendations for the diagnosis of gout were published in 2006. A task force was formed and following a systematic review, they voted unanimously for changes in all items of the 2006 recommendations.