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2020 recommendations from the French Society of Rheumatology for the management of gout: Urate-lowering therapy.
Joint Bone Spine. 2020 Oct; 87(5):395-404.JB

Abstract

OBJECTIVE

To develop French Society of Rheumatology-endorsed recommendations for the management of urate-lowering therapy (ULT).

METHODS

Evidence-based recommendations were developed by 9 rheumatologists (academic or community-based), 3 general practitioners, 1 cardiologist, 1 nephrologist and 1 patient, using a systematic literature search, one physical meeting to draft recommendations and two Delphi rounds to finalize them.

RESULTS

A set of 3 overarching principles and 5 recommendations was elaborated. The overarching principles emphasize the importance of patient education, especially the need for explaining the objective of lowering serum urate (SU) level to obtain crystal dissolution, clinical symptoms disappearance and avoidance of complications. ULT is indicated as soon as the diagnosis of gout is established. SU level must be decreased below 300μmol/l (50mg/l) in all gout patients or at least below 360μmol/l (60ml/l) when the 300μmol/l target cannot be reached, and must be maintained at these targets and monitored life-long. The choice of the ULT primarily relies on renal function: in patients whose estimated glomerular filtration rate (eGFR) is above 60ml/min/1.73m2, first-line ULT is allopurinol; in those with eGFR between 30 and 60ml/min/1.73m2, allopurinol use must be cautious and febuxostat can be considered as an alternative; and in those whose eGFR is below 30ml/min/1.73m2, allopurinol must be avoided and febuxostat should be preferred. Prophylaxis of ULT-induced gout flares involves progressive increase of ULT dosage and low-dose colchicine for at least 6 months. Cardiovascular risk factors and diseases, the metabolic syndrome and chronic kidney disease must be screened and managed.

CONCLUSION

These recommendations aim to provide simple and clear guidance for the management of ULT in France.

Links

Publisher Full Text (DOI)

Authors+Show Affiliations

Pascart T
Service de rhumatologie, université de Lille, GH de l'institut catholique de Lille, Lille, France; EA4490, physiopathologie des maladies osseuses inflammatoires, université de Lille, Lille, France.
Latourte A
Service de rhumatologie, hôpital Lariboisière, AP-HP, 2, rue Ambroise-Paré, 75010 Paris, France; Inserm U1132 BIOSCAR, université de Paris, Paris, France.
Flipo RM
Service de rhumatologie, université de Lille, CHU de Lille, Lille, France.
Chalès G
Faculté de médecine de Rennes, Rennes, France.
Coblentz-Baumann L
Département de médecine générale, université de Paris, Paris, France.
Cohen-Solal A
Service de cardiologie, hôpital Lariboisière, AP-HP, Paris, France; Inserm U942 MASCOT, université de Paris, Paris, France.
Ea HK
Service de rhumatologie, hôpital Lariboisière, AP-HP, 2, rue Ambroise-Paré, 75010 Paris, France; Inserm U1132 BIOSCAR, université de Paris, Paris, France.
Grichy J
Exercice libéral, Montlignon, France.
Letavernier E
Service de physiologie, hôpital Tenon, AP-HP, Paris, France; Inserm U1155, UPMC Université Paris 6, Sorbonne Universités, Paris, France.
Lioté F
Service de rhumatologie, hôpital Lariboisière, AP-HP, 2, rue Ambroise-Paré, 75010 Paris, France; Inserm U1132 BIOSCAR, université de Paris, Paris, France.
Ottaviani S
Service de rhumatologie, hôpital Bichat, AP-HP, Paris, France.
Sigwalt P
Service de rhumatologie, hôpital Lariboisière, AP-HP, 2, rue Ambroise-Paré, 75010 Paris, France; Inserm U1132 BIOSCAR, université de Paris, Paris, France.
Vandecandelaere G
Exercice libéral, Saint-Omer, France.
Richette P
Service de rhumatologie, hôpital Lariboisière, AP-HP, 2, rue Ambroise-Paré, 75010 Paris, France; Inserm U1132 BIOSCAR, université de Paris, Paris, France.
Bardin T
Service de rhumatologie, hôpital Lariboisière, AP-HP, 2, rue Ambroise-Paré, 75010 Paris, France; Inserm U1132 BIOSCAR, université de Paris, Paris, France. Electronic address: thomas.bardin@aphp.fr.

MeSH

AllopurinolFranceGoutGout SuppressantsHumansRheumatologyUric Acid

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32422338

Citation

Pascart, Tristan, et al. "2020 Recommendations From the French Society of Rheumatology for the Management of Gout: Urate-lowering Therapy." Joint Bone Spine, vol. 87, no. 5, 2020, pp. 395-404.
Pascart T, Latourte A, Flipo RM, et al. 2020 recommendations from the French Society of Rheumatology for the management of gout: Urate-lowering therapy. Joint Bone Spine. 2020;87(5):395-404.
Pascart, T., Latourte, A., Flipo, R. M., Chalès, G., Coblentz-Baumann, L., Cohen-Solal, A., Ea, H. K., Grichy, J., Letavernier, E., Lioté, F., Ottaviani, S., Sigwalt, P., Vandecandelaere, G., Richette, P., & Bardin, T. (2020). 2020 recommendations from the French Society of Rheumatology for the management of gout: Urate-lowering therapy. Joint Bone Spine, 87(5), 395-404. https://doi.org/10.1016/j.jbspin.2020.05.002
Pascart T, et al. 2020 Recommendations From the French Society of Rheumatology for the Management of Gout: Urate-lowering Therapy. Joint Bone Spine. 2020;87(5):395-404. PubMed PMID: 32422338.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - 2020 recommendations from the French Society of Rheumatology for the management of gout: Urate-lowering therapy. AU - Pascart,Tristan, AU - Latourte,Augustin, AU - Flipo,René-Marc, AU - Chalès,Gérard, AU - Coblentz-Baumann,Laurence, AU - Cohen-Solal,Alain, AU - Ea,Hang-Korng, AU - Grichy,Jacques, AU - Letavernier,Emmanuel, AU - Lioté,Frédéric, AU - Ottaviani,Sébastien, AU - Sigwalt,Pierre, AU - Vandecandelaere,Guy, AU - Richette,Pascal, AU - Bardin,Thomas, Y1 - 2020/05/15/ PY - 2020/04/03/received PY - 2020/05/07/accepted PY - 2020/5/19/pubmed PY - 2021/6/29/medline PY - 2020/5/19/entrez KW - Allopurinol KW - Education KW - Febuxostat KW - Gout KW - Prophylaxis KW - Urate lowering therapy SP - 395 EP - 404 JF - Joint bone spine JO - Joint Bone Spine VL - 87 IS - 5 N2 - OBJECTIVE: To develop French Society of Rheumatology-endorsed recommendations for the management of urate-lowering therapy (ULT). METHODS: Evidence-based recommendations were developed by 9 rheumatologists (academic or community-based), 3 general practitioners, 1 cardiologist, 1 nephrologist and 1 patient, using a systematic literature search, one physical meeting to draft recommendations and two Delphi rounds to finalize them. RESULTS: A set of 3 overarching principles and 5 recommendations was elaborated. The overarching principles emphasize the importance of patient education, especially the need for explaining the objective of lowering serum urate (SU) level to obtain crystal dissolution, clinical symptoms disappearance and avoidance of complications. ULT is indicated as soon as the diagnosis of gout is established. SU level must be decreased below 300μmol/l (50mg/l) in all gout patients or at least below 360μmol/l (60ml/l) when the 300μmol/l target cannot be reached, and must be maintained at these targets and monitored life-long. The choice of the ULT primarily relies on renal function: in patients whose estimated glomerular filtration rate (eGFR) is above 60ml/min/1.73m2, first-line ULT is allopurinol; in those with eGFR between 30 and 60ml/min/1.73m2, allopurinol use must be cautious and febuxostat can be considered as an alternative; and in those whose eGFR is below 30ml/min/1.73m2, allopurinol must be avoided and febuxostat should be preferred. Prophylaxis of ULT-induced gout flares involves progressive increase of ULT dosage and low-dose colchicine for at least 6 months. Cardiovascular risk factors and diseases, the metabolic syndrome and chronic kidney disease must be screened and managed. CONCLUSION: These recommendations aim to provide simple and clear guidance for the management of ULT in France. SN - 1778-7254 UR - https://www.unboundmedicine.com/medline/citation/32422338/2020_recommendations_from_the_French_Society_of_Rheumatology_for_the_management_of_gout:_Urate_lowering_therapy_ DB - PRIME DP - Unbound Medicine ER -