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GOUT

Can gout management guidelines be solely evidence based?

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The ACR has published an update to its guideline on gout management, which was mostly based on the results of randomized controlled trials (RCTs). Although rigorous, the methodology used for these recommendations can be called into questioned given the lack of robust data from RCTs on all aspects of gout.

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References

  1. Kuo, C. F. et al. Global epidemiology of gout: prevalence, incidence and risk factors. Nat. Rev. Rheumatol. 11, 649–662 (2015).

    Article  Google Scholar 

  2. Richette, P. et al. 2016 updated EULAR evidence-based recommendations for the management of gout. Ann. Rheum. Dis. 76, 29–42 (2017).

    Article  CAS  Google Scholar 

  3. Pascart, T. et al. 2020 recommendations from the French Society of Rheumatology for the management of gout: urate-lowering therapy. Joint Bone Spine https://doi.org/10.1016/j.jbspin.2020.05.002 (2020).

    Article  PubMed  Google Scholar 

  4. FitzGerald, J. D. et al. 2020 American College of Rheumatology guideline for the management of gout. Arthritis Rheumatol. 72, 879–895 (2020).

    Article  Google Scholar 

  5. Sheridan, D. J. & Julian, D. G. Achievements and limitations of evidence-based medicine. J. Am. Col. Cardiol. 68, 204–213 (2016).

    Article  Google Scholar 

  6. Dalbeth, N. et al. Discordant American College of Physicians and international rheumatology guidelines for gout management: consensus statement of the Gout, Hyperuricemia and Crystal- Associated Disease Network (G-CAN). Nat. Rev. Rheumatol. 13, 561–568 (2017).

    Article  Google Scholar 

  7. Richette, P. et al. Response: Renal dosing of allopurinol results in suboptimal gout care by T. Neogi et al. Ann. Rheum. Dis. 76, e2 (2017).

    Article  Google Scholar 

  8. White, W. B. et al. Cardiovascular safety of febuxostat or allopurinol in patients with gout. N. Engl. J. Med. 378, 1200–1210 (2018).

    Article  CAS  Google Scholar 

  9. Ghang, B. et al. Discontinuing febuxostat might cause more deaths than continuing febuxostat: the untold story from the CARES trial. Rheumatology 59, 1439–1440 (2020).

    Article  Google Scholar 

  10. MacDonald, T. M. et al. Protocol of the Febuxostat versus Allopurinol Streamlined Trial (FAST): a large prospective, randomised, open, blinded endpoint study comparing the cardiovascular safety of allopurinol and febuxostat in the management of symptomatic hyperuricaemia. BMJ Open 4, e005354 (2014).

    Article  Google Scholar 

Download references

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Correspondence to Thomas Bardin.

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Competing interests

T.B. declares that he has received advisory fees from AstraZeneca, Grunenthal and Novartis, and educational presentation fees from Astellas, Grunenthal and Novartis. P.R. declares that he has received fees from AstraZeneca, Ipsen Pharma/Menarini and Savient.

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Bardin, T., Richette, P. Can gout management guidelines be solely evidence based?. Nat Rev Rheumatol 16, 479–480 (2020). https://doi.org/10.1038/s41584-020-0471-8

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