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

被引:174
|
作者
Richette, P. [1 ,2 ,3 ]
Doherty, M. [4 ]
Pascual, E. [5 ]
Barskova, V. [6 ]
Becce, F. [7 ]
Castaneda-Sanabria, J. [8 ,9 ,10 ,11 ]
Coyfish, M. [12 ]
Guillo, S. [8 ,9 ,10 ,11 ]
Jansen, T. L. [13 ,14 ]
Janssens, H. [15 ]
Liote, F. [1 ,2 ,3 ]
Mallen, C. [16 ]
Nuki, G. [17 ]
Perez-Ruiz, F. [18 ]
Pimentao, J. [19 ]
Punzi, L. [20 ]
Pywel, T. [12 ]
So, A. [21 ,22 ]
Tausche, A. K. [23 ]
Uhlig, T. [24 ]
Zavada, J. [25 ,26 ]
Zhang, W. [4 ]
Tubach, F. [8 ,9 ,10 ,11 ]
Bardin, T. [1 ,2 ,3 ]
机构
[1] Hop Lariboisiere, AP HP, Serv Rhumatol, F-75010 Paris, France
[2] Hop Lariboisiere, INSERM, UMR1132, F-75010 Paris, France
[3] Univ Paris Diderot, Sorbonne Paris Cite, F-75205 Paris, France
[4] Univ Nottingham, Acad Rheumatol, Nottingham, England
[5] Hosp Gen Univ Alicante, Dept Rheumatol, Alicante, Spain
[6] Inst Rheumatol RAMS, Moscow, Russia
[7] Univ Lausanne Hosp, Dept Diagnost & Intervent Radiol, Lausanne, Switzerland
[8] Hop Bichat Claude Bernard, AP HP, Dept Epiehmiol & Rech Clin, Paris, France
[9] Ctr Pharmacoepiehmiol, Paris, France
[10] Univ Paris Diderot, Paris, France
[11] INSERM, UMR ECEVE 1123, Paris, France
[12] Patient Nottingham, UK, Paris, France
[13] VieCuri Med Ctr, Dept Rheumatol, Venlo, Netherlands
[14] Radboud UMC, Sci IQ HealthCare, Nijmegen, Netherlands
[15] Radboud Univ Nijmegen, Dept Primary & Community Care, Med Ctr, Nijmegen, Netherlands
[16] Keele Univ, Arthrit Res UK Primary Care Ctr, Keele, Staffs, England
[17] Univ Edinburgh, Osteoarticular Res Grp, Edinburgh, Midlothian, Scotland
[18] Hosp Cruces, Secc Rheumatol, Baracaldo, Spain
[19] Clin Coracao Jesus, Rheumatol Unit, Lisbon, Portugal
[20] Univ Padua, Rheumatol Unit, Padua, Italy
[21] CHU Vaudois, Serv Rhumatol, Lausanne, Switzerland
[22] Univ Lausanne, Lausanne, Switzerland
[23] Tech Univ Dresden, Dept Rheumatol, Univ Clin, Dresden, Germany
[24] Diakonhjemmet Hosp, Dept Rheumatol, Oslo, Norway
[25] Charles Univ Prague, Fac Med 1, Inst Rheumatol, Prague, Czech Republic
[26] Charles Univ Prague, Fac Med 1, Dept Rheumatol, Prague, Czech Republic
关键词
SERUM URIC-ACID; URATE-LOWERING THERAPY; QUALITY-OF-LIFE; RANDOMIZED CONTROLLED-TRIALS; ACUTE MYOCARDIAL-INFARCTION; CUTANEOUS ADVERSE-REACTIONS; PLACEBO-CONTROLLED TRIAL; STANDARDIZED OPERATING PROCEDURES; NUTRITION EXAMINATION SURVEY; XANTHINE-OXIDASE INHIBITION;
D O I
10.1136/annrheumdis-2016-209707
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
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 <6 mg/dL (360 mu mol/L) and <5 mg/dL (300 mu mol/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.
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页码:29 / 42
页数:14
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