300 mg/day 37 up to the maximum FDA‐approved dose of 800 mg/day 38), tolerability, safety, and lower cost. Read your poster over carefully to check for spelling mistakes. This updated guideline effort also identifies several areas that inform a research agenda for gout management. Guidelines and recommendations developed and endorsed by the ACR are subject to periodic revision as warranted by the evolution of medical knowledge, technology, and practice. 7 Fig. Under GRADE methodology, recommendations in these guidelines are supported by higher quality studies than the 2012 ACR Guidelines for the Management of Gout. Poster authors are responsible for removing their posters at the end of the day. For PICO questions specific to ULT, and on the basis of input from 1) the Patient Panel; 2) prior focus group work citing the importance of SU, gout flare, and tophi to patients 19; and 3) prior guidance from the GRADE working group 20, we made the following decisions. and you may need to create a new Wiley Online Library account. Patients additionally had contraindication to treatment with allopurinol or history of treatment failure to normalize uric acid despite ≥3 months of treatment with the maximum medically appropriate allopurinol dose (determined by the treating physician). In contrast to the 2012 ACR Guidelines for the Management of Gout (which did not consider treatment costs), this document firmly places allopurinol as the preferred first‐line ULT for all patients, including those with CKD, due to the respective cost of each medication and potential CVD safety concerns that have recently emerged with febuxostat 72. At the time of abstract submission, the submitter must identify who will be the presenting author. Breaking from prior ACR and European League Against Rheumatism (EULAR) guidelines, this guideline does not specify SU thresholds beyond <6 mg/dl for patient subsets with more severe disease (e.g., those with tophi). Fig. A group consensus process was used to compose the final recommendations and grade their strength as strong or conditional. To limit the risk of ULT‐related flares, these guidelines reinforce prior recommendations to use concurrent antiinflammatory prophylaxis for 3–6 months’ duration, a shorter duration than advocated for in prior recommendations, but one that should be extended in the setting of frequent ongoing flares. The Voting Panel recognized that desensitization protocols 69, 70 are not commonly used, with the majority of currently practicing rheumatologists having limited experience in these protocols. These guidelines reinforce the strategy of starting with low‐dose ULT and titrating up to achieve the SU target. ACR recommendations are not intended to dictate payment or insurance decisions, and drug formularies or other third‐party analyses that cite ACR guidelines should state this. Download Translations. Medications noted above are known to have effects on SU concentrations 110. Applying these more conservative rules, the summary certainty of evidence decreased (in comparison to the reported results) for some of the ULT recommendation statements, which would result in a lower strength of recommendation for 2 recommendations (PICO question 2: ULT indication for patients with erosions, and PICO question 27: switching to pegloticase for ULT failure). RANZCR Iodinated Contrast Guidelines Download pdf - 2.3MB This Iodinated Contrast Media Guideline is intended to assist The Royal Australian and New Zealand College of Radiologists®, its staff, Fellows, members and other individuals involved in the administration of iodinated contrast media to patients undergoing medical imaging procedures. While there are associations between SU and other comorbid conditions such as hypertension, CVD, and CKD 116, the benefit (or risk) of ULT in the absence of gout has yet to be established 117. Indications for ULT are expanded from the 2012 ACR Guidelines for the Management of Gout, but consistent with the 2016 update of the EULAR gout recommendations 10, to include individuals with evidence of radiographic damage attributable to gout (using any modality, regardless of subcutaneous tophi or flare frequency). Accepted submissions will be published in the same online supplement of Arthritis and Rheumatology as the 2018 scientific abstracts, and displayed as a digital poster … ; Access the meetings archive to view abstracts from previous meetings. This guideline is not intended to contradict or dispute prior recommendations. Dr. Dalbeth has received consulting fees, speaking fees, and/or honoraria from Janssen, AbbVie, Dyve Biosciences, Arthrosi Therapeutics, Horizon, AstraZeneca, and Hengrui (less than $10,000 each). Interdisciplinary approach to the management of patients with chronic gout. In a small cohort (n = 11) of obese patients, a mean weight loss of 5 kg resulted in a mean SU lowering of 1.1 mg/dl 96. Errors and discrepancies in radiology: frequency, causes, prevention and Management. Number of times cited according to CrossRef: An update on gout diagnosis and management for the primary care provider. the Article by FitzGerald et al. Response to the 2020 American College of Rheumatology Guideline for the Management of Gout: Comment on Appropriate dosing and duration should be guided by the severity of the flare. To facilitate the 2 NMAs, we also considered medications not available in the US to permit comparisons with other available medications in the network analysis. Testing for this allele among Asians and African American patients was reported to be cost‐effective (incremental cost‐effectiveness ratios <$109,000 per quality‐adjusted life years) 67. Posters should be in Portrait format (other size or dimensions will not be accepted). A large observational study (recruitment not selected for CVD) did not show an increased risk of CVD or all‐cause mortality associated with febuxostat initiation compared with allopurinol using methods to address confounding by indication 73. Limit your poster presentation to a few main ideas. Allopurinol desensitization: a fast or slow protocol? However, changes in body mass index (BMI) over time were associated with the risk of recurrent gout flare. If therapy is well‐tolerated and not burdensome, the Patient Panel expressed a preference to continue treatment. Patients with evidence of monosodium urate monohydrate (MSU) deposition on advanced imaging may still be considered asymptomatic if they have not had a prior gout flare or subcutaneous tophi. The Voting Panel considered the impact of weight loss and specific dietary programs (including the DASH diet 103). A single observational study demonstrated that higher levels of 24‐hour urinary uric acid and higher levels of undissociated urinary uric acid were associated with urolithiasis 75. Several studies and a systematic literature review 104 addressed weight loss approaches either directly 96, 105 or indirectly (e.g., bariatric surgery 106, 107, or dietary advice 108). Gout flare was specified as the only critical outcome for management of lifestyle factors. Medication costs (not part of the systematic literature review), reported as average wholesale pricing as sourced from Lexicomp on August 23, 2019, were provided to the Voting Panel, as cost of treatment was included as part of the evaluation of risks and benefits of treatment medications (see Supplementary Appendix 9, available on the Arthritis Care & Research web site at http://onlin​elibr​ary.wiley.com/doi/10.1002/acr.24180/​abstract). The Core Team prespecified outcomes as critical or important for each PICO question for the systematic literature review. The level of evidence supporting this recommendation was very low 69, 70. The effects of a healthy diet, Mediterranean diet, or Dietary Approaches to Stop Hypertension (DASH) diet were even smaller 92. All authors were involved in drafting the article or revising it critically for important intellectual content, and all authors approved the final version to be submitted for publication. This guideline is limited in commenting on specific groups of gout patients, as more studies of specific patient cohorts are needed in order to make differential recommendations. Abstracts are available for the meetings listed below. The Voting Panel reviewed the data for cherries/cherry extract and dairy protein. Patients on this panel articulated that SU assessments reinforced the importance of treatment adherence. A small cohort study demonstrated that despite receiving ULT, heavy drinkers (≥30 units of alcohol/week) were more likely to continue having gout flares compared with those who do did not drink heavily 95. Working off-campus? Real-world patterns of pegloticase use for treatment of gout: descriptive multidatabase cohort study. to fenofibrate despite its urate‐lowering effects 112, as the risks, including side effects of the medication, were felt to outweigh potential benefits. Shop affordable wall art to hang in dorms, bedrooms, offices, or anywhere blank walls aren't welcome. 2011 2011 ACR/ARHP Annual Meeting November 4-9, 2011 • Chicago, Illinois PDF Only (17.8 MB) 2010 2010 ACR/ARHP Annual Meeting November 6-11, 2010 • Atlanta, Georgia PDF Only (16.7 MB) 2009 2009 ACR/ARHP Annual Meeting October 16-21, […] Lacking data on optimal titration regimens, the Voting Panel indicated that titration should be individualized, based on available provider resources (e.g., staff for augmented delivery of care), patient preferences, the timing of ambulatory encounters, and antiinflammatory treatments. medwireNews: Patients with rheumatic diseases taking biologic therapy were more likely to shield during the first 6 months of the COVID-19 pandemic than those taking other drug types, shows research reported at the ACR Convergence 2020 virtual meeting.. Presenting the findings in a late-breaking poster session, Mark Yates (King's College London, UK) explained: “When the pandemic hit, … Likewise, parenteral glucocorticoids were favored over alternative agents when oral dosing is not possible. For patients who are treated with uricosurics, patients should receive counseling about adequate hydration, but they need not be prescribed alkalinizing agents given the lack of evidence for efficacy. ACR Accreditation 1891 Preston White Dr. Reston, VA 20191. High Rate of Adherence to Urate-Lowering Treatment in Patients with Gout: Who’s to Blame?. A small study of 12 patients undergoing bariatric surgery (mean 34.3 kg weight loss over 12 months) demonstrated a mean SU reduction of 2.0 mg/dl 106. The strength of each recommendation was rated as strong or conditional. Prevalence of Urolithiasis by Ultrasonography Among Patients with Gout: A Cross-Sectional Study from the UP-Philippine General Hospital. All other outcomes were specified as important. 2 A report prepared by the SEDENTEXCT project www.sedentexct.eu. For these patients with frequent gout flares or nonresolving subcutaneous tophi, clinical trials demonstrated improved SU concentrations, low frequency of flares 77, reduction in tophi 21, and improved quality of life 22 among those receiving pegloticase. However, the panel recognized that these resources may not be available in all health care settings, and that the key is for the treating provider (who could be the treating physician) to educate the patient and implement a treat‐to‐target protocol. In a single study (moderate certainty of evidence), patients with ≤2 previous flares (and no more than 1 gout flare in the preceding year) randomized to receive febuxostat (versus placebo) were less likely to experience a subsequent flare (30% versus 41%; P < 0.05) 27. We thank N. Lawrence Edwards, MD, for his review of the manuscript. After cessation, monitoring for flare activity and continuation of antiinflammatory treatment as needed if the patient continues to experience flares was recommended. Dr. Neogi had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. 3): 1–150 The best care starts with the best information. The SEDENTEXCT project (2008-2011) … While the etiology of gout is well‐understood and there are effective and inexpensive medications to treat gout, gaps in quality of care persist 2-4. The Voting Panel aimed to provide guidance without implying any “patient‐blaming” for the manifestations of gout given its strong genetic determinants. Dr. FitzGerald holds a patent for a lens‐free microscope. 2. Abbreviations: ACR, albumin:creatinine ratio; CKD, chronic kidney disease; GFR, glomerular filtration rate Adapted with permission from Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group (2013) KDIGO 2012 clinical practice guideline for the evaluation and management of chronic kidney disease. Also added were conditional recommendations (which would warrant provider‐patient shared medical decision‐making discussion) for ULT use in patients with either infrequent flares (<2 flares/year) or a first flare with marked hyperuricemia (SU >9 mg/dl). The full text of this article hosted at iucr.org is unavailable due to technical difficulties. However, we found no studies directly addressing the choice in the above PICO question, resulting in the conditional recommendation to switch to a second XOI after the first XOI failure (for recommendations for consideration of changing ULT strategy, see Table 5 and Supplementary Figure 2, available at http://onlinelibrary.wiley.com/doi/10.1002/acr.24180/abstract). In a single case series where ULT was withheld in patients in clinical remission with years of well‐controlled SU concentrations prior to cessation, only 13% of patients (27 of 211) whose SU concentration remained at <7 mg/dl while not receiving ULT had no flares during a 5‐year follow‐up period. Fitzgerald, Dalbeth, Mikuls, Guyatt, Mount, Pillinger, Singh, P. Khanna, Kim, Sehra, Sharma, Toprover, Zeng, Turner, Neogi. Underscoring the importance of optimal flare management, the Patient Panel emphasized its preference for early intervention given the challenges of engaging a provider in timely manner, including an at‐home “medication‐in‐pocket” strategy for patients who are able to identify the early signs of flare onset. Two separate pharmacist‐led interventions in the US, both incorporating treat‐to‐target strategies, were superior to usual care in terms of treatment adherence, SU outcomes, and higher allopurinol dosing 60, 61. In ACR-TIRADS, the threshold size to perform a FNA are 2.5cm (TR3), 1.5cm (TR4) and 1 cm (TR5). In the National Health and Nutrition Examination Survey, artificially sweetened carbonated beverage consumption was associated with higher SU levels 101. To accomplish this second NMA, we grouped similar agents into nodes (e.g., acetic acid derivatives, profens, cyclooxygenase 2 agents, glucocorticoids, and interleukin‐1 [IL‐1] inhibitors). Furthermore, input from the Patient Panel emphasized that patients are likely to be highly motivated to take ULT due to the symptoms related to the current flare. The ESR uses the ACR's guidelines as a starting point for reviewed and adapted guidelines for use in Europe. Kidney International (Suppl. As an example, a unit of beer raised SU concentrations by 0.16 mg/dl. The Voting Panel indicated that an optimal trial of oral medication would be appropriate prior to pegloticase due to cost differences and potential adverse effects of the latter medication (for recommendations for choice of initial ULT, see Table 2 and Supplementary Figure 2, available at http://onlinelibrary.wiley.com/doi/10.1002/acr.24180/abstract). As data continue to emerge supporting best practices in management, implementation of these recommendations will ideally lead to improved quality of care for patients with gout. Likewise, the Voting Panel specifically recommended against adding or switching cholesterol‐lowering agents (e.g., statins, bile acid sequestrants, nicotinic acid agents, etc.) Using GRADE methodology and informed by a consensus process based on evidence from the current literature and patient preferences, this guideline provides direction for clinicians and patients making decisions on the management of gout. Furthermore, treatment options for gout flare are limited in this population, and there may be added benefit of using ULT to prevent progression of renal disease 31. 2021 abstract presentation guidelines coming soon. Due to small sample sizes, studies of patients without gout (or not defined), and risk of bias assessments, the certainty of the evidence was rated as very low for both SU and flares. The last proposed soution is for consideration in the near future and involves investing in a point of care (POC) creatinine device, with the cheapest device costing £4,995. The following articles provide helpful advice on the entire scientific communication process, from writing the abstract to delivering the poster or oral presentation. A population pharmacokinetic–pharmacodynamics study showed that larger body size and diuretic use indicated the need for higher allopurinol doses to achieve greater urate reduction. Unique Radiology Posters designed and sold by artists. GRADE guidelines: 22. Without standardized definitions for gout flare as an outcome 18, flare definitions varied by duration of follow‐up in the various studies. The details are available in the evidence report (Supplementary Appendix 8). Febuxostat, however, was associated with a higher risk of CVD‐related death and all‐cause mortality (driven by CVD deaths) compared with allopurinol, but there was no association with the other 3 secondary CVD outcomes (nonfatal myocardial infarction, nonfatal stroke, or urgent revascularization for unstable angina). Overview of breast manifestations of systemic disease A pictorial review of Breast Lymphoma… Emphasize important points on the poster with lines, frames or … Even lower initial allopurinol doses (e.g., ≤50 mg/day) should be considered in patients with CKD. To clarify, as outlined above, there is a strong recommendation to follow a treat‐to‐target management strategy for all patients receiving ULT. Similar to the 2012 ACR Guidelines for the Management of Gout, the Voting Panel advocated a “medication‐in‐pocket” strategy for gout flare management, which the Patient Panel reinforced as a preferred approach. In the absence of “rapid” access to an effective oral medication, the Patient Panel also indicated its preference for an injectable therapy in appropriate circumstances to achieve pain relief as quickly as possible (for all recommendations for gout flare managment, see Table 6 and Supplementary Figure 4, available at http://onlinelibrary.wiley.com/doi/10.1002/acr.24180/abstract). 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For patients with only infrequent flares, the magnitude of benefit would be substantially smaller than for patients with frequent flares, and there would be no benefit in reduction of tophi when no tophi are present. Conditional recommendations reflect scenarios for which the benefits and risks may be more closely balanced and/or only low certainty of evidence or no data are available. Watch past educational presentations and see live events in real time, Reference our medication guides for helpful information. The certainty of evidence drawn mainly from observational studies was low or very low, precluding specific recommendations on these topics. Use the link below to share a full-text version of this article with your friends and colleagues. For patients with asymptomatic hyperuricemia, RCTs (designed to study CVD outcomes) demonstrated significant reduction in incident gout flares over 3 years. Do patient preferences for core outcome domains for chronic gout studies support the validity of composite response criteria? As noted in the ACR Clinical Quality Measures for Gout, SU concentrations should be checked after each dose titration 113. However, in contrast to a treatment strategy using an SU target of <6 mg/dl as studied in clinical trials 43, there are no trial data to support lower specific thresholds for such patients. While many Patient Panel participants reported that they were initially hesitant to start ULT, after experiencing improved control of inflammatory symptoms and tophi, they became strong advocates for its earlier institution (for all indications for pharmacologic ULT, see Table 1 and Supplementary Figure 1, available at http://onlinelibrary.wiley.com/doi/10.1002/acr.24180/abstract). Since the 2012 ACR Guidelines for the Management of Gout were published, several clinical trials have been conducted that provide additional evidence regarding the management of gout, leading the ACR Guidelines Subcommittee to determine that new guidelines were warranted. Dr. D. Khanna has received consulting fees, speaking fees, and/or honoraria from Horizon (less than $10,000) and owns stock or stock options in Eicos Sciences. Additionally, we report results using the more conservative rating of the evidence using the lowest level of evidence for any of the critical outcomes. A lower starting dose of any ULT reduces the risk of flare associated with initiation 41. Other studies have demonstrated that allopurinol dose escalation can be done safely in this population 40, 45. ACR policy guided the management of conflicts of interest and disclosures ( https://www.rheum​atolo​gy.org/Pract​ice-Quali​ty/Clini​cal-Suppo​rt/Clini​cal-Pract​ice-Guide​lines/​Gout). Specific characteristics for patients with infrequent flares (e.g., SU concentration >9 mg/dl, CKD, CVD) that might influence the risk‐benefit assessment were considered, but due to insufficient data for these subgroups, the Voting Panel did not find that these conditions warranted stronger ULT recommendations specific to these subgroups. However, the Voting Panel indicated that the challenges with 24‐hour urine collection or nomogram‐based testing, which can both be affected by diet, negate the utility of such testing in light of a very low level of evidence. In contrast to the 2012 ACR Guidelines for the Management of Gout, due to lack of supporting evidence for additional specific thresholds, we do not define further thresholds for patients warranting more intensive ULT. Order your ACR poster presentation by November 10th, 2014 to have it on time for the upcoming conference. To be eligible to present, authors will be required to confirm they had full access to all of the data in the study and take responsibility for the integrity of the data, accuracy of the data analysis, and approving the data for presentation. In the Nurses’ Health Study, greater consumption of high‐fructose corn syrup was associated with higher risk of incident gout 102. © 2020 American College of Rheumatology. Asian and African American patients taking allopurinol both have a 3‐fold increased risk of AHS compared with white patients taking allopurinol 68 (for recommendations for ULT medications, see Table 4 and Supplementary Figure 3, available at http://onlinelibrary.wiley.com/doi/10.1002/acr.24180/abstract). If you are ready to order click on the button below to start. Go to http://www.eee.manchester.ac.uk/our-research/postgraduate-poster-conference/ Updates to the guidelines for the management of rheumatoid arthritis (RA) and juvenile idiopathic arthritis (JIA) were previewed at the American College of Rheumatology (ACR… However, these outcomes come with high costs, twice‐monthly infusions, and the potential for serious allergic reactions. Using a lower starting dose mitigates safety issues specific to allopurinol hypersensitivity syndrome (AHS) 39, 40. However, a small RCT (n = 29, with all participants receiving ULT with SU at target at the start of trial) using an educational intervention focused on low purine intake did not demonstrate lower SU concentrations compared with usual diet, despite significant improvements in patient dietary knowledge 99. Dr. Mikuls has received consulting fees from Pfizer (less than $10,000) and research support from Horizon Therapeutics and Bristol‐Myers Squibb. Shop affordable wall art to hang in dorms, bedrooms, offices, or anywhere blank walls aren't welcome. Two small RCTs 57, 58 and an observational study 59 support the hypothesis that starting ULT during a flare does not significantly extend flare duration or severity. For patients with a history of urolithiasis, allopurinol and febuxostat provide benefit, as both medications lower 24‐hour urinary uric acid excretion more than placebo 33. All rights reserved. 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 complete list of identifiers can be found under the "Safe Harbor method” on the Health and Human Services website. Please ensure that you have read the abstract submission guidelines and submit all abstracts by the deadlines shown below. At a face‐to‐face meeting, the Voting Panel again reviewed draft recommendations, a summary of the voting results from round 1, the evidence report, and a summary of Patient Panel statements (1 patient from the Patient Panel [JES] and the Patient Panel moderator [JAS] attended the Voting Panel and were available to answer questions about the Patient Panel statements). Adherence to urate-lowering therapy while following the national guidelines for the management of patients with gout (preliminary evidence). vs PICO questions were posted on the ACR web site for public comment (October 30–November 30, 2018) (for a list of team and panel members, see Supplementary Appendix 2, available on the Arthritis Care & Research web site at http://onlin​elibr​ary.wiley.com/doi/10.1002/acr.24180/​abstract). Moreover, the lack of an untreated control group means the absolute CVD risk related to febuxostat is unknown. The Voting Panel strongly recommended allopurinol as the preferred first‐line agent given its efficacy when dosed appropriately (often required doses >300 mg/day 37 up to the maximum FDA‐approved dose of 800 mg/day 38), tolerability, safety, and lower cost. Read your poster over carefully to check for spelling mistakes. This updated guideline effort also identifies several areas that inform a research agenda for gout management. Guidelines and recommendations developed and endorsed by the ACR are subject to periodic revision as warranted by the evolution of medical knowledge, technology, and practice. 7 Fig. Under GRADE methodology, recommendations in these guidelines are supported by higher quality studies than the 2012 ACR Guidelines for the Management of Gout. Poster authors are responsible for removing their posters at the end of the day. For PICO questions specific to ULT, and on the basis of input from 1) the Patient Panel; 2) prior focus group work citing the importance of SU, gout flare, and tophi to patients 19; and 3) prior guidance from the GRADE working group 20, we made the following decisions. and you may need to create a new Wiley Online Library account. Patients additionally had contraindication to treatment with allopurinol or history of treatment failure to normalize uric acid despite ≥3 months of treatment with the maximum medically appropriate allopurinol dose (determined by the treating physician). In contrast to the 2012 ACR Guidelines for the Management of Gout (which did not consider treatment costs), this document firmly places allopurinol as the preferred first‐line ULT for all patients, including those with CKD, due to the respective cost of each medication and potential CVD safety concerns that have recently emerged with febuxostat 72. At the time of abstract submission, the submitter must identify who will be the presenting author. Breaking from prior ACR and European League Against Rheumatism (EULAR) guidelines, this guideline does not specify SU thresholds beyond <6 mg/dl for patient subsets with more severe disease (e.g., those with tophi). Fig. A group consensus process was used to compose the final recommendations and grade their strength as strong or conditional. To limit the risk of ULT‐related flares, these guidelines reinforce prior recommendations to use concurrent antiinflammatory prophylaxis for 3–6 months’ duration, a shorter duration than advocated for in prior recommendations, but one that should be extended in the setting of frequent ongoing flares. The Voting Panel recognized that desensitization protocols 69, 70 are not commonly used, with the majority of currently practicing rheumatologists having limited experience in these protocols. These guidelines reinforce the strategy of starting with low‐dose ULT and titrating up to achieve the SU target. ACR recommendations are not intended to dictate payment or insurance decisions, and drug formularies or other third‐party analyses that cite ACR guidelines should state this. Download Translations. Medications noted above are known to have effects on SU concentrations 110. Applying these more conservative rules, the summary certainty of evidence decreased (in comparison to the reported results) for some of the ULT recommendation statements, which would result in a lower strength of recommendation for 2 recommendations (PICO question 2: ULT indication for patients with erosions, and PICO question 27: switching to pegloticase for ULT failure). RANZCR Iodinated Contrast Guidelines Download pdf - 2.3MB This Iodinated Contrast Media Guideline is intended to assist The Royal Australian and New Zealand College of Radiologists®, its staff, Fellows, members and other individuals involved in the administration of iodinated contrast media to patients undergoing medical imaging procedures. While there are associations between SU and other comorbid conditions such as hypertension, CVD, and CKD 116, the benefit (or risk) of ULT in the absence of gout has yet to be established 117. Indications for ULT are expanded from the 2012 ACR Guidelines for the Management of Gout, but consistent with the 2016 update of the EULAR gout recommendations 10, to include individuals with evidence of radiographic damage attributable to gout (using any modality, regardless of subcutaneous tophi or flare frequency). Accepted submissions will be published in the same online supplement of Arthritis and Rheumatology as the 2018 scientific abstracts, and displayed as a digital poster … ; Access the meetings archive to view abstracts from previous meetings. This guideline is not intended to contradict or dispute prior recommendations. Dr. Dalbeth has received consulting fees, speaking fees, and/or honoraria from Janssen, AbbVie, Dyve Biosciences, Arthrosi Therapeutics, Horizon, AstraZeneca, and Hengrui (less than $10,000 each). Interdisciplinary approach to the management of patients with chronic gout. In a small cohort (n = 11) of obese patients, a mean weight loss of 5 kg resulted in a mean SU lowering of 1.1 mg/dl 96. Errors and discrepancies in radiology: frequency, causes, prevention and Management. Number of times cited according to CrossRef: An update on gout diagnosis and management for the primary care provider. the Article by FitzGerald et al. Response to the 2020 American College of Rheumatology Guideline for the Management of Gout: Comment on Appropriate dosing and duration should be guided by the severity of the flare. To facilitate the 2 NMAs, we also considered medications not available in the US to permit comparisons with other available medications in the network analysis. Testing for this allele among Asians and African American patients was reported to be cost‐effective (incremental cost‐effectiveness ratios <$109,000 per quality‐adjusted life years) 67. Posters should be in Portrait format (other size or dimensions will not be accepted). A large observational study (recruitment not selected for CVD) did not show an increased risk of CVD or all‐cause mortality associated with febuxostat initiation compared with allopurinol using methods to address confounding by indication 73. Limit your poster presentation to a few main ideas. Allopurinol desensitization: a fast or slow protocol? However, changes in body mass index (BMI) over time were associated with the risk of recurrent gout flare. If therapy is well‐tolerated and not burdensome, the Patient Panel expressed a preference to continue treatment. Patients with evidence of monosodium urate monohydrate (MSU) deposition on advanced imaging may still be considered asymptomatic if they have not had a prior gout flare or subcutaneous tophi. The Voting Panel considered the impact of weight loss and specific dietary programs (including the DASH diet 103). A single observational study demonstrated that higher levels of 24‐hour urinary uric acid and higher levels of undissociated urinary uric acid were associated with urolithiasis 75. Several studies and a systematic literature review 104 addressed weight loss approaches either directly 96, 105 or indirectly (e.g., bariatric surgery 106, 107, or dietary advice 108). Gout flare was specified as the only critical outcome for management of lifestyle factors. Medication costs (not part of the systematic literature review), reported as average wholesale pricing as sourced from Lexicomp on August 23, 2019, were provided to the Voting Panel, as cost of treatment was included as part of the evaluation of risks and benefits of treatment medications (see Supplementary Appendix 9, available on the Arthritis Care & Research web site at http://onlin​elibr​ary.wiley.com/doi/10.1002/acr.24180/​abstract). The Core Team prespecified outcomes as critical or important for each PICO question for the systematic literature review. The level of evidence supporting this recommendation was very low 69, 70. The effects of a healthy diet, Mediterranean diet, or Dietary Approaches to Stop Hypertension (DASH) diet were even smaller 92. All authors were involved in drafting the article or revising it critically for important intellectual content, and all authors approved the final version to be submitted for publication. This guideline is limited in commenting on specific groups of gout patients, as more studies of specific patient cohorts are needed in order to make differential recommendations. Abstracts are available for the meetings listed below. The Voting Panel reviewed the data for cherries/cherry extract and dairy protein. Patients on this panel articulated that SU assessments reinforced the importance of treatment adherence. A small cohort study demonstrated that despite receiving ULT, heavy drinkers (≥30 units of alcohol/week) were more likely to continue having gout flares compared with those who do did not drink heavily 95. Working off-campus? Real-world patterns of pegloticase use for treatment of gout: descriptive multidatabase cohort study. to fenofibrate despite its urate‐lowering effects 112, as the risks, including side effects of the medication, were felt to outweigh potential benefits. Shop affordable wall art to hang in dorms, bedrooms, offices, or anywhere blank walls aren't welcome. 2011 2011 ACR/ARHP Annual Meeting November 4-9, 2011 • Chicago, Illinois PDF Only (17.8 MB) 2010 2010 ACR/ARHP Annual Meeting November 6-11, 2010 • Atlanta, Georgia PDF Only (16.7 MB) 2009 2009 ACR/ARHP Annual Meeting October 16-21, […] Lacking data on optimal titration regimens, the Voting Panel indicated that titration should be individualized, based on available provider resources (e.g., staff for augmented delivery of care), patient preferences, the timing of ambulatory encounters, and antiinflammatory treatments. medwireNews: Patients with rheumatic diseases taking biologic therapy were more likely to shield during the first 6 months of the COVID-19 pandemic than those taking other drug types, shows research reported at the ACR Convergence 2020 virtual meeting.. Presenting the findings in a late-breaking poster session, Mark Yates (King's College London, UK) explained: “When the pandemic hit, … Likewise, parenteral glucocorticoids were favored over alternative agents when oral dosing is not possible. For patients who are treated with uricosurics, patients should receive counseling about adequate hydration, but they need not be prescribed alkalinizing agents given the lack of evidence for efficacy. ACR Accreditation 1891 Preston White Dr. Reston, VA 20191. High Rate of Adherence to Urate-Lowering Treatment in Patients with Gout: Who’s to Blame?. A small study of 12 patients undergoing bariatric surgery (mean 34.3 kg weight loss over 12 months) demonstrated a mean SU reduction of 2.0 mg/dl 106. The strength of each recommendation was rated as strong or conditional. Prevalence of Urolithiasis by Ultrasonography Among Patients with Gout: A Cross-Sectional Study from the UP-Philippine General Hospital. All other outcomes were specified as important. 2 A report prepared by the SEDENTEXCT project www.sedentexct.eu. For these patients with frequent gout flares or nonresolving subcutaneous tophi, clinical trials demonstrated improved SU concentrations, low frequency of flares 77, reduction in tophi 21, and improved quality of life 22 among those receiving pegloticase. However, the panel recognized that these resources may not be available in all health care settings, and that the key is for the treating provider (who could be the treating physician) to educate the patient and implement a treat‐to‐target protocol. In a single study (moderate certainty of evidence), patients with ≤2 previous flares (and no more than 1 gout flare in the preceding year) randomized to receive febuxostat (versus placebo) were less likely to experience a subsequent flare (30% versus 41%; P < 0.05) 27. We thank N. Lawrence Edwards, MD, for his review of the manuscript. After cessation, monitoring for flare activity and continuation of antiinflammatory treatment as needed if the patient continues to experience flares was recommended. Dr. Neogi had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. 3): 1–150 The best care starts with the best information. The SEDENTEXCT project (2008-2011) … While the etiology of gout is well‐understood and there are effective and inexpensive medications to treat gout, gaps in quality of care persist 2-4. The Voting Panel aimed to provide guidance without implying any “patient‐blaming” for the manifestations of gout given its strong genetic determinants. Dr. FitzGerald holds a patent for a lens‐free microscope. 2. Abbreviations: ACR, albumin:creatinine ratio; CKD, chronic kidney disease; GFR, glomerular filtration rate Adapted with permission from Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group (2013) KDIGO 2012 clinical practice guideline for the evaluation and management of chronic kidney disease. Also added were conditional recommendations (which would warrant provider‐patient shared medical decision‐making discussion) for ULT use in patients with either infrequent flares (<2 flares/year) or a first flare with marked hyperuricemia (SU >9 mg/dl). The full text of this article hosted at iucr.org is unavailable due to technical difficulties. However, we found no studies directly addressing the choice in the above PICO question, resulting in the conditional recommendation to switch to a second XOI after the first XOI failure (for recommendations for consideration of changing ULT strategy, see Table 5 and Supplementary Figure 2, available at http://onlinelibrary.wiley.com/doi/10.1002/acr.24180/abstract). In a single case series where ULT was withheld in patients in clinical remission with years of well‐controlled SU concentrations prior to cessation, only 13% of patients (27 of 211) whose SU concentration remained at <7 mg/dl while not receiving ULT had no flares during a 5‐year follow‐up period. Fitzgerald, Dalbeth, Mikuls, Guyatt, Mount, Pillinger, Singh, P. Khanna, Kim, Sehra, Sharma, Toprover, Zeng, Turner, Neogi. Underscoring the importance of optimal flare management, the Patient Panel emphasized its preference for early intervention given the challenges of engaging a provider in timely manner, including an at‐home “medication‐in‐pocket” strategy for patients who are able to identify the early signs of flare onset. Two separate pharmacist‐led interventions in the US, both incorporating treat‐to‐target strategies, were superior to usual care in terms of treatment adherence, SU outcomes, and higher allopurinol dosing 60, 61. In ACR-TIRADS, the threshold size to perform a FNA are 2.5cm (TR3), 1.5cm (TR4) and 1 cm (TR5). In the National Health and Nutrition Examination Survey, artificially sweetened carbonated beverage consumption was associated with higher SU levels 101. To accomplish this second NMA, we grouped similar agents into nodes (e.g., acetic acid derivatives, profens, cyclooxygenase 2 agents, glucocorticoids, and interleukin‐1 [IL‐1] inhibitors). Furthermore, input from the Patient Panel emphasized that patients are likely to be highly motivated to take ULT due to the symptoms related to the current flare. The ESR uses the ACR's guidelines as a starting point for reviewed and adapted guidelines for use in Europe. Kidney International (Suppl. As an example, a unit of beer raised SU concentrations by 0.16 mg/dl. The Voting Panel indicated that an optimal trial of oral medication would be appropriate prior to pegloticase due to cost differences and potential adverse effects of the latter medication (for recommendations for choice of initial ULT, see Table 2 and Supplementary Figure 2, available at http://onlinelibrary.wiley.com/doi/10.1002/acr.24180/abstract). As data continue to emerge supporting best practices in management, implementation of these recommendations will ideally lead to improved quality of care for patients with gout. Likewise, the Voting Panel specifically recommended against adding or switching cholesterol‐lowering agents (e.g., statins, bile acid sequestrants, nicotinic acid agents, etc.) Using GRADE methodology and informed by a consensus process based on evidence from the current literature and patient preferences, this guideline provides direction for clinicians and patients making decisions on the management of gout. Furthermore, treatment options for gout flare are limited in this population, and there may be added benefit of using ULT to prevent progression of renal disease 31. 2021 abstract presentation guidelines coming soon. Due to small sample sizes, studies of patients without gout (or not defined), and risk of bias assessments, the certainty of the evidence was rated as very low for both SU and flares. The last proposed soution is for consideration in the near future and involves investing in a point of care (POC) creatinine device, with the cheapest device costing £4,995. The following articles provide helpful advice on the entire scientific communication process, from writing the abstract to delivering the poster or oral presentation. A population pharmacokinetic–pharmacodynamics study showed that larger body size and diuretic use indicated the need for higher allopurinol doses to achieve greater urate reduction. Unique Radiology Posters designed and sold by artists. GRADE guidelines: 22. Without standardized definitions for gout flare as an outcome 18, flare definitions varied by duration of follow‐up in the various studies. The details are available in the evidence report (Supplementary Appendix 8). Febuxostat, however, was associated with a higher risk of CVD‐related death and all‐cause mortality (driven by CVD deaths) compared with allopurinol, but there was no association with the other 3 secondary CVD outcomes (nonfatal myocardial infarction, nonfatal stroke, or urgent revascularization for unstable angina). Overview of breast manifestations of systemic disease A pictorial review of Breast Lymphoma… Emphasize important points on the poster with lines, frames or … Even lower initial allopurinol doses (e.g., ≤50 mg/day) should be considered in patients with CKD. To clarify, as outlined above, there is a strong recommendation to follow a treat‐to‐target management strategy for all patients receiving ULT. Similar to the 2012 ACR Guidelines for the Management of Gout, the Voting Panel advocated a “medication‐in‐pocket” strategy for gout flare management, which the Patient Panel reinforced as a preferred approach. In the absence of “rapid” access to an effective oral medication, the Patient Panel also indicated its preference for an injectable therapy in appropriate circumstances to achieve pain relief as quickly as possible (for all recommendations for gout flare managment, see Table 6 and Supplementary Figure 4, available at http://onlinelibrary.wiley.com/doi/10.1002/acr.24180/abstract). 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