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How Would You Manage This Patient With Gout?: Grand Rounds Discussion From Beth Israel Deaconess Medical Center.
Ann Intern Med 2018; 169(11):788-795AIM

Abstract

Gout is the most common form of inflammatory arthritis. In 2012, the American College of Rheumatology (ACR) issued a guideline, which was followed in 2017 by one from the American College of Physicians (ACP). The guidelines agree on treating acute gout with a corticosteroid, nonsteroidal anti-inflammatory drug, or colchicine and on not initiating long-term urate-lowering therapy (ULT) for most patients after a first gout attack and in those whose attacks are infrequent (<2 per year). However, they differ on treatment of both recurrent gout and problematic gout. The ACR advocates a "treat-to-target" approach, and the ACP did not find enough evidence to support this approach and offered an alternative strategy that bases intensity of ULT on the goal of avoiding recurrent gout attacks ("treat-to-avoid-symptoms") with no monitoring of urate levels. They also disagree on the role of a gout-specific diet. Here, a general internist and a rheumatologist discuss these guidelines; they debate how they would manage an acute attack of gout, if and when to initiate ULT, and the goals for ULT. Lastly, they offer specific advice for a patient who is uncertain about whether to begin this therapy.

Authors+Show Affiliations

Beth Israel Deaconess Medical Center, Boston, Massachusetts (R.B.B., C.C.S., R.H.S., A.T.).Beth Israel Deaconess Medical Center, Boston, Massachusetts (R.B.B., C.C.S., R.H.S., A.T.).Beth Israel Deaconess Medical Center, Boston, Massachusetts (R.B.B., C.C.S., R.H.S., A.T.).Beth Israel Deaconess Medical Center, Boston, Massachusetts (R.B.B., C.C.S., R.H.S., A.T.).

Pub Type(s)

Case Reports
Clinical Conference
Journal Article

Language

eng

PubMed ID

30508444

Citation

Burns, Risa B., et al. "How Would You Manage This Patient With Gout?: Grand Rounds Discussion From Beth Israel Deaconess Medical Center." Annals of Internal Medicine, vol. 169, no. 11, 2018, pp. 788-795.
Burns RB, Smith CC, Shmerling RH, et al. How Would You Manage This Patient With Gout?: Grand Rounds Discussion From Beth Israel Deaconess Medical Center. Ann Intern Med. 2018;169(11):788-795.
Burns, R. B., Smith, C. C., Shmerling, R. H., & Tess, A. (2018). How Would You Manage This Patient With Gout?: Grand Rounds Discussion From Beth Israel Deaconess Medical Center. Annals of Internal Medicine, 169(11), pp. 788-795. doi:10.7326/M18-2548.
Burns RB, et al. How Would You Manage This Patient With Gout?: Grand Rounds Discussion From Beth Israel Deaconess Medical Center. Ann Intern Med. 2018 12 4;169(11):788-795. PubMed PMID: 30508444.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - How Would You Manage This Patient With Gout?: Grand Rounds Discussion From Beth Israel Deaconess Medical Center. AU - Burns,Risa B, AU - Smith,C Christopher, AU - Shmerling,Robert H, AU - Tess,Anjala, PY - 2018/12/4/entrez PY - 2018/12/7/pubmed PY - 2019/8/31/medline SP - 788 EP - 795 JF - Annals of internal medicine JO - Ann. Intern. Med. VL - 169 IS - 11 N2 - Gout is the most common form of inflammatory arthritis. In 2012, the American College of Rheumatology (ACR) issued a guideline, which was followed in 2017 by one from the American College of Physicians (ACP). The guidelines agree on treating acute gout with a corticosteroid, nonsteroidal anti-inflammatory drug, or colchicine and on not initiating long-term urate-lowering therapy (ULT) for most patients after a first gout attack and in those whose attacks are infrequent (<2 per year). However, they differ on treatment of both recurrent gout and problematic gout. The ACR advocates a "treat-to-target" approach, and the ACP did not find enough evidence to support this approach and offered an alternative strategy that bases intensity of ULT on the goal of avoiding recurrent gout attacks ("treat-to-avoid-symptoms") with no monitoring of urate levels. They also disagree on the role of a gout-specific diet. Here, a general internist and a rheumatologist discuss these guidelines; they debate how they would manage an acute attack of gout, if and when to initiate ULT, and the goals for ULT. Lastly, they offer specific advice for a patient who is uncertain about whether to begin this therapy. SN - 1539-3704 UR - https://www.unboundmedicine.com/medline/citation/30508444/How_Would_You_Manage_This_Patient_With_Gout:_Grand_Rounds_Discussion_From_Beth_Israel_Deaconess_Medical_Center_ L2 - https://www.annals.org/article.aspx?doi=10.7326/M18-2548 DB - PRIME DP - Unbound Medicine ER -