학술논문
2020 American College of Rheumatology Guideline for the Management of Gout.
Document Type
article
Author
Dalbeth, Nicola; Mikuls, Ted; Brignardello-Petersen, Romina; Guyatt, Gordon; Abeles, Aryeh; Gelber, Allan; Harrold, Leslie; Khanna, Dinesh; King, Charles; Levy, Gerald; Libbey, Caryn; Mount, David; Pillinger, Michael; Rosenthal, Ann; Singh, Jasvinder; Sims, James; Smith, Benjamin; Wenger, Neil; Bae, Sangmee; Danve, Abhijeet; Khanna, Puja; Kim, Seoyoung; Lenert, Aleksander; Poon, Samuel; Qasim, Anila; Sehra, Shiv; Sharma, Tarun; Toprover, Michael; Turgunbaev, Marat; Zeng, Linan; Zhang, Mary; Turner, Amy; Neogi, Tuhina; FitzGerald, John
Source
Arthritis Care & Research. 72(6)
Subject
Language
Abstract
OBJECTIVE: To provide guidance for the management of gout, including indications for and optimal use of urate-lowering therapy (ULT), treatment of gout flares, and lifestyle and other medication recommendations. METHODS: Fifty-seven population, intervention, comparator, and outcomes questions were developed, followed by a systematic literature review, including network meta-analyses with ratings of the available evidence according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology, and patient input. A group consensus process was used to compose the final recommendations and grade their strength as strong or conditional. RESULTS: Forty-two recommendations (including 16 strong recommendations) were generated. Strong recommendations included initiation of ULT for all patients with tophaceous gout, radiographic damage due to gout, or frequent gout flares; allopurinol as the preferred first-line ULT, including for those with moderate-to-severe chronic kidney disease (CKD; stage >3); using a low starting dose of allopurinol (≤100 mg/day, and lower in CKD) or febuxostat (