An in‐person Patient Panel of 8 male patients with gout, moderated by one of the voting panel members (JAS), reviewed the evidence report (along with a summary and interpretation by the moderator) and provided patient perspectives and preferences. Clinical discussion: gout therapy in a comorbid patient. A full description of the methods is presented in Supplementary Appendix 1 (available on the Arthritis Care & Research web site at http://onlinelibrary.wiley.com/doi/10.1002/acr.24180/abstract). The details are available in the evidence report (Supplementary Appendix 8). As an example, a unit of beer raised SU concentrations by 0.16 mg/dl. These guidelines are also available on the Poster Presenter Management Site. An increase in BMI of >5% was associated with 60% higher odds of recurrent flare, and a decrease in BMI of >5% was associated with 40% lower odds of recurrent flare compared with those without weight change (–3.5% < BMI < 3.5%) 105. Gout flare was specified as the only critical outcome for management of lifestyle factors. Shop affordable wall art to hang in dorms, bedrooms, offices, or anywhere blank walls aren't welcome. The Voting Panel endorsed 42 recommendations overall, including 16 strong recommendations focused on ULT management (indications [n = 3], initiation [n = 6], titration and treat‐to‐target approach [n = 2], approaches following ULT failure [n = 2]), and flare management (n = 3). Likewise, gout patients losing weight through bariatric surgery or diet experienced reduced flare frequency 108, although patients undergoing bariatric surgery may actually have a transient increase in flares risk during the first postoperative month 106. In a large cohort study, obesity was associated with a higher risk of incident gout, but not recurrent gout flares 105. To clarify, as outlined above, there is a strong recommendation to follow a treat‐to‐target management strategy for all patients receiving ULT. See videos to help answer your questions. Dr. Mikuls has received consulting fees from Pfizer (less than $10,000) and research support from Horizon Therapeutics and Bristol‐Myers Squibb. 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. sodium bicarbonate on urine alkalization in Chinese primary gout patients with benzbromarone: a prospective, randomized controlled study Your poster will be delivered as early as the next business day to your home, hotel or school. ACR … Among patients with calcium oxalate stones and hyperuricosuria, allopurinol (300 mg/day) is superior to placebo in reducing the 3‐year incidence of stone‐related events 34. The GRADE approach for tests and strategies‐from test accuracy to patient‐important outcomes and recommendations, Tophus burden reduction with pegloticase: results from phase 3 randomized trials and open‐label extension in patients with chronic gout refractory to conventional therapy, Improved health‐related quality of life and physical function in patients with refractory chronic gout following treatment with pegloticase: evidence from phase III randomized controlled trials, Efficacy and tolerability of pegloticase for the treatment of chronic gout in patients refractory to conventional treatment: two randomized controlled trials, Lesinurad monotherapy in gout patients intolerant to a xanthine oxidase inhibitor: a 6‐month phase 3 clinical trial and extension study, Lesinurad, a selective uric acid reabsorption inhibitor, in combination with febuxostat in patients with tophaceous gout: findings of a phase III clinical trial, A retrospective study of the relationship between serum urate 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acute gouty arthritis flares during initiation of allopurinol treatment: results of a double‐blind, randomised study, Rilonacept (interleukin‐1 trap) for prevention of gout flares during initiation of uric acid–lowering therapy: results from a phase III randomized, double‐blind, placebo‐controlled, confirmatory efficacy study, Rilonacept for gout flare prevention in patients receiving uric acid‐lowering therapy: results of RESURGE, a phase III, international safety study, Effects of colchicine on risk of cardiovascular events and mortality among patients with gout: a cohort study using electronic medical records linked with Medicare claims, Prophylaxis of acute flares when initiating febuxostat for chronic gouty arthritis in a real‐world clinical setting, Febuxostat compared with allopurinol in patients with hyperuricemia and gout, Effects of febuxostat versus allopurinol and placebo in reducing serum urate in subjects with hyperuricemia and gout: a 28‐week, phase III, randomized, double‐blind, parallel‐group trial, Does starting allopurinol prolong acute treated gout? 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. For patients with less frequent flares and no tophi, the potential clinical benefit of ULT would be lower than the ULT benefit for patients with more burdensome gout. the Article by FitzGerald et al. Order your ACR poster presentation by November 10th, 2014 to have it on time for the upcoming conference. For patients in clinical remission taking ULT (e.g., no flares for ≥1 year and no tophi 63), the Voting Panel considered ULT cessation or tapering. 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. 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. 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. 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). The Voting Panel discussed data demonstrating the important genetic contributions to the development and severity of hyperuricemia and gout 92, 93 and informally recommended that providers be mindful when soliciting information regarding the dietary habits of patients and ensure that discussions regarding dietary recommendations are not misinterpreted as “patient‐blaming,” as patients frequently feel stigmatized when discussing gout with their providers 94. For management of gout flares, colchicine, nonsteroidal antiinflammatory drugs, or glucocorticoids (oral, intraarticular, or intramuscular) were strongly recommended. However, concerns about starting ULT during a flare include potential extension or worsening of a flare, as well as the possibility of information overload for patients, which may lead to conflating flare management and long‐term ULT. The full text of this article hosted at iucr.org is unavailable due to technical difficulties. Continuation of prophylaxis for at least 3–6 months after ULT initiation was recommended because shorter durations were associated with flares upon cessation of prophylaxis 55, 56. Fig. The level of evidence supporting this recommendation was very low 69, 70. Fitzgerald, Dalbeth, Mikuls, Brignardello‐Petersen, Khanna, Rosenthal, Bae, Danve, P. Khanna, Kim, Lenert, Poon, Qasim, Sehra, Sharma, Toprover, Turgunbaev, Zeng, Zhang, Neogi. We would like to show you a description here but the site won’t allow us. Gout has differential impact on patients by sex, race, or by presence of other comorbidities. In other words, 24 patients would need to be treated with ULT for 3 years to prevent a single (incident) gout flare. Notifications for late-breaking abstracts will be sent (coming soon). 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. 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