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New Gout Guidelines for Patients and Physicians

  • Published: 2012-09-29 : Author: Wiley
  • Synopsis: New guidelines that educate patients in effective methods to prevent gout attacks and provide physicians with recommended therapies for long-term management.
Gout
Gout - Other terms include: Gouty arthritis - acute; Gout - acute; Hyperuricemia; Tophaceous gout; Tophi; Podagra; Gout - chronic; Chronic gout; Acute gout; Acute gouty arthritis. Gout is a kind of arthritis that occurs when uric acid builds up in blood and causes joint inflammation. Gout is caused by having higher-than-normal levels of uric acid in your body. The exact cause is unknown. Gout may run in families. It is more common in men, in women after menopause, and those who drink alcohol. People who take certain medicines, such as hydrochlorothiazide and other water pills, may have higher levels of uric acid in the blood.

Main Document

Gout is one of the most common forms of inflammatory arthritis, affecting nearly 4% of adult Americans. Newly approved guidelines that educate patients in effective methods to prevent gout attacks and provide physicians with recommended therapies for long-term management of this painful disease are published in Arthritis Care & Research, a peer-reviewed journal of the American College of Rheumatology (ACR).

Uric acid is produced by the metabolism of purines, which are found in foods and human tissue. When uric acid levels increase, crystals can form and deposit in joints, causing excruciating pain and swelling typical of an acute gout flare. Doctor-diagnosed gout has risen over the past 20 years and now affects 8.3 million individuals in the U.S., according to a July 2011 study published in Arthritis & Rheumatism. Medical evidence suggests that the increased prevalence of elevated uric acid levels (hyperuricemia) and gout may be attributed to such factors as hypertension, obesity, metabolic syndrome, type 2 diabetes, and the extensive treatment with thiazide and loop diuretics for cardiovascular disease.

"Acute gout attacks can be debilitating and adversely affect patients' quality of life," says lead investigator John D. Fitzgerald, MD, PhD, Acting Rheumatology Division Chief at the University of California, Los Angeles (UCLA). "In order to improve patient care, the ACR funded this collaborative effort among U.S. researchers to produce guidelines, outlining pharmacological therapies and non-drug treatments to manage gout."

Dr. Fitzgerald and fellow co-leaders Drs. Robert Terkeltaub (senior and corresponding author, from the VA and UCSD system), Dinesh Khanna and Puja P. Khanna (from the University of Michigan and VA system) reviewed medical literature from the 1950s to the present. A task force panel including seven rheumatologists, two primary care physicians, a nephrologist, and a patient representative then ranked and voted upon recommendations to create the two-part ACR gout guidelines.

Part I guidelines focus on the systematic non-pharmacologic and pharmacologic therapeutic approaches to hyperuricemia and include:

Part II guidelines cover therapy and prophylactic anti-inflammatory treatment for acute gouty arthritis. These guidelines recommend that physicians:

Dr. Fitzgerald concludes, "The ACR gout guidelines are designed to emphasize safety, quality of therapy, and to reflect best practice based upon medical evidence available at this time. Our goal is that these guidelines, along with educating gout patients in effective treatment, will improve adherence, quality of care and management of this painful and potentially chronically debilitating condition."

These studies are published in Arthritis Care & Research.

Full citations: "2012 American College of Rheumatology Guidelines for Management of Gout Part I: Systematic Non-pharmacologic and Pharmacologic Therapeutic Approaches to Hyperuricemia." Dinesh Khanna, John D. FitzGerald, Puja P. Khanna, Sangmee Bae, Manjit Singh, Tuhina Neogi, Michael H. Pillinger, Joan Merill, Susan Lee, Shraddha Prakash, Marian Kaldas, Maneesh Gogia, Fernando Perez-Ruiz, Will Taylor, Frederic Liote, Hyon Choi, Jasvinder A. Singh,Nicola Dalbeth, Sanford Kaplan, Vandana Niyyar, Danielle Jones, Steven A. Yarows, Blake Roessler, Gail Kerr, Charles King, Gerald Levy, Daniel E. Furst, N. Lawrence Edwards, Brian Mandell, H. Ralph Schumacher, Mark Robbins, Neil Wenger, Robert Terkeltaub. Arthritis Care and Research; Published Online: September 28, 2012 (DOI: 10.1002/acr.21772).

"2012 American College of Rheumatology Guidelines for Management of Gout Part II: Therapy and Anti-inflammatory Prophylaxis of Acute Gouty Arthritis." Dinesh Khanna, Puja P. Khanna, John D. FitzGerald, Manjit K. Singh, Sangmee Bae, Tuhina Neogi, Michael H. Pillinger, Joan Merill, Susan Lee, Shraddha Prakash, Marian Kaldas, Maneesh Gogia, Fernando Perez-Ruiz, Will Taylor, Frederic Liote, Hyon Choi, Jasvinder A. Singh, Nicola Dalbeth, Sanford Kaplan, Vandana Niyyar, Danielle Jones, Steven A. Yarows, Blake Roessler, Gail Kerr, Charles King, Gerald Levy, Daniel E. Furst, N. Lawrence Edwards, Brian Mandell, H. Ralph Schumacher, Mark Robbins, Neil Wenger, Robert Terkeltaub. Arthritis Care and Research; Published Online: September 28, 2012 (DOI: 10.1002/acr.21773).

Arthritis Care & Research is an official journal of the American College of Rheumatology (ACR), and the Association of Rheumatology Health Professionals (ARHP), a division of the College. Arthritis Care & Research is a peer-reviewed research publication that publishes both original research and review articles that promote excellence in the clinical practice of rheumatology. Relevant to the care of individuals with arthritis and related disorders, major topics are evidence-based practice studies, clinical problems, practice guidelines, health care economics, health care policy, educational, social, and public health issues, and future trends in rheumatology practice. The journal is published by Wiley on behalf of the American College of Rheumatology (ACR). For more information, please visit wileyonlinelibrary.com/journal/acr.

About Wiley: Founded in 1807, John Wiley & Sons, Inc. has been a valued source of information and understanding for more than 200 years, helping people around the world meet their needs and fulfill their aspirations. Wiley and its acquired companies have published the works of more than 450 Nobel laureates in all categories: Literature, Economics, Physiology or Medicine, Physics, Chemistry, and Peace.

Our core businesses publish scientific, technical, medical, and scholarly journals, encyclopedias, books, and online products and services; professional/trade books, subscription products, training materials, and online applications and Web sites; and educational materials for undergraduate and graduate students and lifelong learners. Wiley's global headquarters are located in Hoboken, New Jersey, with operations in the U.S., Europe, Asia, Canada, and Australia. The Company's Web site can be accessed at www.wiley.com. The Company is listed on the New York Stock Exchange under the symbols JWa and JWb.

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