2016 updated EULAR evidence-based recommendations for the PDF annrheumdis-2016-209707.full.pdf

25 juil 2016 · Richette P, et al Ann Rheum Dis 2016;0:1–14 doi:10 1136/annrheumdis-2016- 209707 1 care source population found that prednisolone (35 mg/day for Switzerland) since 2010: Ardea BioSciences, AstraZeneca global, AstraZeneca treatment of hyperuricemia in gout: the “dirty dish” hypothesis

3 SEPTEMBER 2010, 85th YEAR / 3 SEPTEMBRE 2010, 85e ANNÉE No 36, 2010, 85, 349–356 The same activities outside health-care facilities are coordinated by the rapidement l'hypothèse de risques immédiats et aigus pour la santé dus à avec THW devait permettre de disposer d'une structure d'ana- lyse et de

[PDF] Loi et règlements sur le courtage immobilier au Québec - OACIQ

CHAPITRE II Exercice du courtage immobilier et hypothécaire 4; 2010, c 40, s 15; 2013, c 18, s 19 5 Le permis de courtier est délivré à la personne the nature, form and tenor of the records books and registers D 295-2010, Ann A

[PDF] Annals of Oncology - RERO DOC

contradiction to our hypothesis, chemotherapy had almost no impact on particular relevance for patient care Its role in for patient care and QL research it has rarely been studied [4] Abstract published in Ann Oncol 1996; 7 (Suppl): 38

[PDF] La déclaration RECORD-PE (Reporting of Studies - CMAJ

POINTS CLÉS • Les directives RECORD (Reporting of Studies Conducted Using home, or were receiving hospice care on the date of their cohort-qualifying

[PDF] Intubation et extubation du patient - SFMU

incluant les données de 15 PICU (pediatric intensive care unit) a récemment permis Une enquête anglaise de 2010 (28) souligne l'importante marge de progression dans aucune grande étude randomisée n'a confirmé cette hypothèse [Complications of difficult tracheal intubations in a critical care unit] Ann Fr

[PDF] American Clinical Neurophysiology Society

Critical care continuous EEG (CCEEG) refers to the simultaneous recording of EEG stroke, and during and after therapeutic hypothermia post cardiac arrest 2010) e The use of CCEEG in ICU patients at risk for NCS leads to changes in Ann Neurol 2013 Claassen J, Taccone FS, Horn P, Holtkamp M, Stocchetti N

2016 updated EULAR evidence-based recommendations for the

[PDF] Guide for the Care and Use of Laboratory Animals, 8th edition

of Laboratory Animal Care International; American Association for Laboratory Animal Science Leigh Ann Clayton, National Aquarium, Baltimore John C at http://oacu od nih gov/regs/USGovtPrncpl htm; accessed May 10, 2010 Klein HJ records, regular veterinary visits to facilities where animals are or may be

[PDF] ADA Standards of Medical Care in Diabetes 2018

trolled hyperglycemia and severe hypo- glycemia tronic health records and quality of diabetes care N Engl J Med Ann Intern Med 2010;153:507–515 72

[PDF] 3 : créer de nouveaux onglets dans Netvibes Cliquer sur le bouton «+» et renommer le nouvel onglet (par exemple Encyclopédies en ligne)

[PDF] Dossier Administratif permanent de l association

[PDF] RECUEIL DES POLITIQUES ADE06-DA ADMINISTRATION DES ÉCOLES Éducation coopérative et autres formes d apprentissage par l expérience

[PDF] EDIWEB - Guide de démarrage rapide

[PDF] SERVICE DE PILOTAGE DU DISPOSITIF DE SORTIE DES EMPRUNTS A RISQUE

[PDF] Nous espérons que ces renseignements, de même que les services rendus, sauront répondre à vos attentes.

[PDF] Ces Lettres d informations sont envoyées aux extranautes inscrits et abonnés sur le site assistance (voir point N 3).

[PDF] CAHIER DES CHARGES ETUDE DE FAISABILITE D UN GEIQ AIDE A DOMICILE EN PAYS DE LA LOIRE

[PDF] 2012 l essentiel de la politique ressources humaines

[PDF] EXAMEN PROFESSIONNEL D ADJOINT ADMINISTRATIF TERRITORIAL DE 1 ère CLASSE

[PDF] Opportunité CICE. Une opportunité à saisir pour financer tous vos projets de développement! Développement. Fonds de roulement

[PDF] UTILISATION DU WEB-FFS SUR FFSSKI (Dépôt des épreuves et inscription des concurrents)

[PDF] Formations NBS SYSTEM, Copyright 2010 1/9. Plan de Formation RSSI

[PDF] Manuel de l utilisateur Intrum Web 2.0

[PDF] Formation PrestaShop: créer un site e-commerce. Programme. Installation et configuration. Mise en place de la boutique.

EXTENDED REPORT

2016 updatedEULARevidence-based

recommendationsforthe managementof gout

P Richette,

M Doherty,

E Pascual,

V Barskova,

F Becce,

J Castañeda-Sanabria,

MCoysh,

S Guillo,

T LJansen,

H Janssens,

F Lioté,

C Mallen,

G Nuki,

F Perez-Ruiz,

J Pimentao,

L Punzi,

T Pywell,

7 A So, 15

A KT ausche,

T Uhlig,

J Zavada,

W Zhang,

F Tubach,

T Bardin

Additional materialis

published onlineonly .Tovie w please visitthe journalonline (http://dx.doi.org/10.1136/ annrheumdis-2016-209707).

Fornumber edafliationssee

end ofarticle.

Correspondenceto

ProfessorP ascalRichette,

FédérationdeRhuma tologie,

CentreViggoP etersen,Hôpital

Lariboisière,2 rueAmbr oise

Paré,P aris75010,France;

pascal.richette@aphp.fr

Received13April 2016

Revised14 June2016

Accepted 29June 2016

Tocite: Richette P,

Doherty M,P ascualE,et al.

Ann RheumDis Published

Online First:[please include

DayMonth Year]

doi:10.1136/annrheumdis-

2016-209707ABSTRACT

BackgroundNewdrugs andne weviden ceconcerning

the useof established treatments havebecomeavailable since thepublic ationoftherstEur opeanLeague

AgainstRheuma tism(EULAR)recommenda tionsfor the

management ofgout, in2006. Thissitu ation has prompteda sy stematicreviewandupdateof the2006 recommendations.

MethodsThe EULARtaskfor ceconsis tedof15

rheumatologists,1radiolog ist, 2generalpractitioners,

1 researchfellow ,2patientsand3experts in

epidemiology/methodologyfr om12European countries.

A systematicreviewofthe literatureconcerning all

aspects ofgout trea tmentswasperformed.

Subsequently,r ecommendationswereformulated byuse

of aDelphi consensus approach.

ResultsThreeo verarchingprinciplesand11key

recommendationswere generated.Forthe treatmentof are,colch icine,non-steroidal anti-inammatorydrugs (NSAIDs), oralorintr a-articular steroidsoracombina tion arer ecommended.Inpatientswith frequent areand contraindicationstocolch icine,NSAIDs and corticosteroids,aninterleukin-1block ershould be considered.In addition toeducationand anon- pharmacologicalmana gementapproach, urate-lowering therapy(UL T)shouldbeconsider edfr omthe rst presentationofthe disease,and serumuric acid (SUA) levelsshould bemaintained at<6 mg/dL(360 mmol/L) and <5mg/dL (300mmol/L)in thosewith sever egout.

Allopurinol isr ecommendedasrst-lineUL Tandits

dosage shouldbe adjusted accordingtor enalfunction. If theSUA targetcannot bea chieved withallopurinol, then febuxostat,auricosuricor combininga xanthine oxidase inhibitorwith auricosuric shouldbe consider ed.

Forpa tientswithrefr actory gout,pegloticaseis

recommended.

ConclusionsThese recommendationsaimtoinform

physiciansand patients aboutthenon-pharma cological and pharmacologicaltreatments forgoutandtopro vide the beststr ategiestoachievetheprede ned uratetarget to curethedisease.

INTRODUCTION

Gout isa disablingand commondisease inEur ope;

its prevalenceranges from0.9%to 2.5%depend- ing onthe country. 1-3

The prevalenceandinci-

dence ofthe diseaseha ve increasedsteadilyin recenty ears,particularlyinthe UK. 45

However,

despite effectivetrea tments,goutisstilloften misdiagnosed andits managementr emainssubopti- mal. 367

This situationprompted theelaboration

of therstEur opeanLeagueAgainst Rheumatism (EULAR) recommendationsforthemanagement of gout,in 2006,which wer ebased onasystema tic literaturereview (SLR)andexpertopinion. 8

Since 2006,our knowledge ofthepathophy si-

ology ofthe diseasehas impro ved greatly 910
and theeld ofgout managementhas advancedquickly .

When therstEULAR recommenda tionswere

produced,the numberof drugsa vailablefor gout treatmentwas limitedandthemain ura te-low ering therapy(UL T)wasallopurinol. Sincethen,a number ofne wdrugshav ebecome availableorare in late-stagedevelopment(ie, febuxostat, pegloti- case, interleukin-1(IL-1) blockers, lesinurad). 11 12

Moreover,additionaldataon established drugs

such ascolchicine 13 and allopurinol 14-16 havebeen published, ands tudieshave repeatedlyidentied increasedcardio vascularmortalitywithgout. 17

Therefore,theindica tionsfor oldandnew drugs

need tobe claried andno veltherapeuticstr ategies recommendedon thebasis oftheir availability ,the patientpr ole, previousdrugfailur eand benet/ risk ratioaswell asthe costofthe variousdrugs nowa vailableforthetr eatment ofareand for loweringura televels.Forthis purpose,ataskfor ce wasconv enedtoupdate the2006 EULARrecom- mendationsfor themanagement ofgout, withthe objectiveof addressing allover arching principles and individualr ecommendationsbyaSLRand expertand patient opinion.

METHODS

Withthe approva loftheEULARex ecutive commit-

tee,the conven or(TB)alongwithtw oco-conv enors oft he2006 taskforce (MDand EP),anepidemiolo - gist(FT) andana cademic rhe umatologist(PR) formedast eer inggrouptoupdateth e2006EULAR recommendationsforthemanagem entof gout.Th e steeringgrouppr ioritisedt heresearchquestions , draftedthemet hodology tobeusedforthesenov el setof rec ommendationsandassembledatask force.

This EULARtask force comprised15rheuma tol-

ogists,1 musculoskeletal radiologist,2 general practitioners(GPs), 1research fellow ,2patients and 3e xpertsinepidemiology/methodologyfr om

12 Europeancountries.The recommenda tions

weredeveloped accordingtothe standardisedoper- atingpr oceduresfortheelabora tion,evalua tion Richette P,et al.Ann RheumDis 2016;0:1-14. doi:10.1136/annrheumdis-2016-2097071

Clinicalande pidemiologicalr esearch

ARD Online First, published on July 25, 2016 as 10.1136/annrheumdis-2016 -209707 Copyright Article author (or their employer) 2016. Produced by BMJ Pub lishing Group Ltd (& EULAR) under licence.

on May 29, 2023 by guest. Protected by copyright.http://ard.bmj.com/Ann Rheum Dis: first published as 10.1136/annrheumdis-2016-209707 on 25

July 2016. Downloaded from

disseminationand implementation ofrecommendations endorsed bythe EULAR. 18 19

Thefirsts tepwasto determinewhetherthe12 former

EULAR recommendations(2006)forthe managementof gout should ber etained,modified orabandoned. For thispurpose, members ofthe taskfor cew eresenta questionnaireandwer e askedto ra teeachrecommendation byusinga9-point numer- ical ratingscale(1,totally disagree; 9,fully agree). Foreach item, participantsindica tedwhetherthey wouldk eepthesame recommendation(firstques tion).Iftheansw erw asscor ed5, the participantsw erethenaskedif they wouldmodifyther ec- ommendation(second question). Itwase xplainedtha tthe phrasingof theupda tedr ecommendationsshouldnot beamere clinical statement - as formos tofthe2006 EULARr ecommen- dations - but whereverpossibleshouldtak ethe formof aclear activerecommenda tionspecific toa particularclinical situation, as advisedby theAppr aisalof GuidelinesforResear ch&

Evaluation(A GREEII).

The steeringgroup hadpredeter-

mined thatanitem from the2006 recommendationswould be deleted ifall scores fromtheparticipants forthefirstques tion were<5with amedian 3.5. Conversely,theitemwouldbe unchanged ifall scores fortothefirstques tionwere 5 witha median7 andwhen allscor esfor thesecondquestion wer e <5 witha median3.5. Ifnot, theitems hadto bemodi fied. Members ofthe taskfor cew erealsoinvited toindicatetopics theywould like toaddressfor additionalr ecommendations. Subsequently,one resear chfellow(JC-S) withthehelpof an expertin sy stematicreviewmethodology(SG)performedan SLR bysear chingforlitera ture publishedsince1January2005 in MEDLINE,EMBASE andC ochrane Librarydatabasesin June 2013.This process includedbothagener alsear chand a proposition-specific search.Thegener alsear chstra tegyconsisted of twobasic components:(1) goutin whatev erpossible termsin the databasesand(2) typesof study designin theforms ofsys- tematicr eview/meta-analysis,randomisedcontrolledtrial (RCT)/controlledtrial, uncontrolled trial,cohortstudy ,case - controls tudy,cross-sectionalstudy .Thetwocomponents were combined tosear chforthecurr enta vailabler esearchevidence on gout.The qualityof evidenceand grades ofr ecommendation weredetermineda ccordingto thestandardsof theOxford

CentreforEvidence-Based Medicine.

The qualityof evidence

wasassessed bythe GRADE method.Criteria forRCTsincluded adequater andomisationandallocationconcealment, prognos tic similarity betweengroups (intermsofthe evaluated outcome), equal follow-upofgr oups,adequa teblinding,validation ofout- comes, applicationofintent-to-tr eat analysis,selectiveoutcome reporting,s toppingearlyforbene fit,fi-risk controlwithmul- tiple comparisonsor multipleoutcomes. Criteriafor observa- tional studiesincludedchoice ofcontr ols,measur ementof both exposuresandoutcomes, confoundingfa ctors,completeness of data,magnitude ofeffect anddose -responsegr adient.Criteria for meta-analysisincludeda priori-defined objectivesandout- comes ofinter est,descriptionoftheliter atur esear ch,selection criteria forincluded studies, assessmentofqualityof studies, evaluationof publication biasandhomogeneityof results. In thene xtstep,all taskforcemembers attended a2-da y meeting duringwhich results oftheSLRw ere presented inan aggregatedform.The taskfor cedeba tedand evaluatedtheevi- dence presentedandformula teda preliminarysetof new recommendations.Then,the taskfor cer eached consensus regardingthe proposed recommendationsby usingtheDelphi sequential votingtechniqueby emaila fterthe meeting. Subsequently,the level ofagreementfor each recommendation

wasgr aded.Eachparticipant wasasked tor ateeach recommendationagainby usingthe 9-pointnumerical ra tingscale (1,totally disagree; 9,fullyagree) andcould propose areformulationofthe recommenda tion.

Subsequently,this setof recommenda tionsw asexternally evaluatedby GPs (n=8)andrheuma tologists (n=5)mainly in independent orpriva tepractice inEurope(theUK,The Netherlands, Spain,F rance,PortugalandItaly). Eachphysicianquotesdbs_dbs6.pdfusesText_11

[PDF] 2016 updated EULAR evidence-based recommendations for the