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Yimaitong compiles and organizes, please do not reprint without authorization
.
Recently, the "2021 Asia-Pacific Rheumatism Association Alliance Gout Treatment Clinical Practice Guidelines" was published in the Int J Rheum Dis journal.
The expert panel members come from 9 countries/regions in the Asia-Pacific region
.
The "Guide" provides 22 recommendations for scenarios such as "acute phase, chronic phase, refractory gout", "asymptomatic hyperuricemia", etc.
, and aims to provide clinical diagnosis and treatment recommendations for Asian patients
.
Yimaitong compiles the core recommendations for reference by teachers
.
(Download at the end of the article) Scenario 1: Treatment of asymptomatic hyperuricemia 1.
Should patients with asymptomatic hyperuricemia and hypertension be treated with uric acid-lowering therapy (ULT)? ➤Guideline recommendations: ULT is not recommended to lower the main heart Risk of vascular events or death (cardiovascular and all-cause)
.
(Strong recommendation, quality of evidence: very low) 2.
Should patients with asymptomatic hyperuricemia and chronic kidney disease be given ULT? ➤Guide recommendations: Can ULT reduce the risk of death, major acute cardiovascular events, or prevent progression to end-stage renal disease? There is not enough evidence to support or disagree
.
Scenario 2: Treatment of acute gout 3.
Recommendations for the treatment of acute gout ➤ Guideline recommendations: In the acute phase of gout, it is recommended to use colchicine, non-steroidal anti-inflammatory drugs or glucocorticoids as first-line treatment to relieve pain
.
(Strong recommendation, quality of evidence: moderate) ➤Guide recommendations: Recommend a low-dose colchicine (1.
5-1.
8 mg/d) regimen to relieve pain
.
(Strong recommendation, quality of evidence: high) ➤Recommendation of the guidelines: "Intra-articular injection of glucocorticoid to relieve pain" is not recommended because there is not enough evidence
.
(Quality of evidence: very low) 4.
Initiation of ULT treatment, in the acute attack or in remission? ➤Guide suggestion: At present, there is not enough evidence to prove which option is better
.
(Quality of Evidence: Low) Scenario 3: Starting ULT, how to prevent gout attacks? 5.
When starting ULT, is colchicine used to prevent gout attacks? ➤Guide recommendations: When starting ULT treatment, it is recommended to use low-dose colchicine to prevent gout attacks
.
(Strong recommendation, quality of evidence: low) 6.
At the beginning of ULT, should NSAIDs be used to prevent gout attacks? ➤Guide recommendations: If colchicine is intolerable or contraindicated, NSAIDs are recommended As a second-line preventive medication
.
(Weak recommendation, quality of evidence: very low) 7.
Are glucocorticoids used to prevent gout attacks when initiating ULT? ➤Guideline recommendations: There is currently insufficient evidence
.
(Quality of evidence: very low) Scenario 4: Uric acid-lowering therapy (ULT) 8.
Should HLA-B*5801 testing be performed before allopurinol treatment? ➤Guideline recommendations: Prevalence of HLA-B*5801 alleles is high In the population with high rate (≥5%), it is recommended to test HLA-B*5801 before starting allopurinol
.
(Weak recommendation, quality of evidence: very low) 9.
Is febuxostat superior to allopurinol in the population with high prevalence of HLA-B*5801? ➤Guide recommendations: Among the population with high prevalence of HLA-B*5801, the guide has a neutral opinion on the "pros and cons of febuxostat and allopurinol"
.
(Weak recommendation, quality of evidence: low) 10.
When should ULT be started for newly diagnosed gout patients? ➤Guideline recommendations: For patients who are newly diagnosed with gout and have a blood uric acid level ≥9 mg/dL (536umol/L), it is recommended to start ULT Treatment to prevent the recurrence of gout
.
(Weak recommendation, quality of evidence: very low) Scenario 5: Treatment of chronic gout (CTG) 11.
For CTG patients, should xanthine oxidase inhibitors be used to dissolve tophi? ➤Guideline recommendations: For patients with chronic gout, corresponding It is recommended to use xanthine oxidase inhibitors (allopurinol or febuxostat) to achieve the dissolution of tophi compared to the absence of ULT
.
(Strong recommendation, quality of evidence: low) 12.
In CTG patients who use xanthine oxidase inhibitors but still have persistent hyperuricemia, should lesinurad be added to dissolve tophi? ➤Guide recommendations: In blood uric acid> 6mg /dL (360umol/L) in chronic gout patients, it is not recommended to add lesinurad to xanthine oxidase inhibitor to dissolve tophi
.
(Weak recommendation, quality of evidence: medium) Scenario 6: Refractory gout and treatment non-responding patients 13.
For patients with refractory gout and treatment non-response ➤ Guidelines suggestion: In refractory adult gout patients, except for "lesinurad + other" "Purinol", there is currently no sufficient evidence to prove that other combinations of drugs that promote uric acid excretion and xanthine oxidase inhibitors can lower blood uric acid levels and reduce gout attacks
.
➤Guide recommendations: For adult patients with refractory gout who are contraindicated or who do not respond well to xanthine oxidase inhibitor therapy, pegloticase (if available) is recommended to achieve blood uric acid goals and prevent gout attacks
.
(Weak recommendation, quality of evidence: medium) Scenario 7: Patients with gout and moderate to severe renal impairment 14.
Should patients with gout and renal impairment use ULT to prevent the progression of chronic kidney disease? ➤Guideline recommendations: No support or opposition, not enough at present Evidence recommends or opposes the use of ULT to prevent the progression of chronic kidney disease
.
(Quality of evidence: very low) Scenario 8: Non-pharmaceutical interventions for gout (NPI) 15.
Should alcohol intake be restricted? ➤Guideline recommendations: It is recommended to limit alcohol intake to prevent acute attacks of gout
.
(Weak recommendation, quality of evidence: very low) 16.
Should the intake of purines be restricted? ➤Guide recommendations: No recommendation is not opposed, there is currently insufficient evidence
.
(Quality of evidence: very low) 17.
Should patients be advised to lose weight? ➤Guide recommendations: For overweight/obese gout patients, weight loss interventions are recommended to prevent gout attacks and lower blood uric acid levels
.
(Weak recommendation, quality of evidence: very low) 18.
Can acupuncture be used to relieve acute gout pain? ➤Recommendation of the guidelines: For patients with acute attacks of gout, if they are intolerant or contraindicated with conventional anti-inflammatory drugs, acupuncture may be a kind of The option to relieve pain
.
(Weak recommendation, quality of evidence: very low) 19.
Is it possible to use herbal medicines to prevent gout attacks? ➤Guideline recommendations: no recommendation is not opposed, there is insufficient evidence
.
(Quality of evidence: very low) Guide download: https://guide.
medlive.
cn/guideline/24761 Yimaitong compiled and compiled from: Lorenzo J, Sollano M, Salido EO, et al.
2021 Asia-Pacific League of Associations for Rheumatology clinical practice guideline for treatment of gout[J].
Int J Rheum Dis, 2021.
.
Recently, the "2021 Asia-Pacific Rheumatism Association Alliance Gout Treatment Clinical Practice Guidelines" was published in the Int J Rheum Dis journal.
The expert panel members come from 9 countries/regions in the Asia-Pacific region
.
The "Guide" provides 22 recommendations for scenarios such as "acute phase, chronic phase, refractory gout", "asymptomatic hyperuricemia", etc.
, and aims to provide clinical diagnosis and treatment recommendations for Asian patients
.
Yimaitong compiles the core recommendations for reference by teachers
.
(Download at the end of the article) Scenario 1: Treatment of asymptomatic hyperuricemia 1.
Should patients with asymptomatic hyperuricemia and hypertension be treated with uric acid-lowering therapy (ULT)? ➤Guideline recommendations: ULT is not recommended to lower the main heart Risk of vascular events or death (cardiovascular and all-cause)
.
(Strong recommendation, quality of evidence: very low) 2.
Should patients with asymptomatic hyperuricemia and chronic kidney disease be given ULT? ➤Guide recommendations: Can ULT reduce the risk of death, major acute cardiovascular events, or prevent progression to end-stage renal disease? There is not enough evidence to support or disagree
.
Scenario 2: Treatment of acute gout 3.
Recommendations for the treatment of acute gout ➤ Guideline recommendations: In the acute phase of gout, it is recommended to use colchicine, non-steroidal anti-inflammatory drugs or glucocorticoids as first-line treatment to relieve pain
.
(Strong recommendation, quality of evidence: moderate) ➤Guide recommendations: Recommend a low-dose colchicine (1.
5-1.
8 mg/d) regimen to relieve pain
.
(Strong recommendation, quality of evidence: high) ➤Recommendation of the guidelines: "Intra-articular injection of glucocorticoid to relieve pain" is not recommended because there is not enough evidence
.
(Quality of evidence: very low) 4.
Initiation of ULT treatment, in the acute attack or in remission? ➤Guide suggestion: At present, there is not enough evidence to prove which option is better
.
(Quality of Evidence: Low) Scenario 3: Starting ULT, how to prevent gout attacks? 5.
When starting ULT, is colchicine used to prevent gout attacks? ➤Guide recommendations: When starting ULT treatment, it is recommended to use low-dose colchicine to prevent gout attacks
.
(Strong recommendation, quality of evidence: low) 6.
At the beginning of ULT, should NSAIDs be used to prevent gout attacks? ➤Guide recommendations: If colchicine is intolerable or contraindicated, NSAIDs are recommended As a second-line preventive medication
.
(Weak recommendation, quality of evidence: very low) 7.
Are glucocorticoids used to prevent gout attacks when initiating ULT? ➤Guideline recommendations: There is currently insufficient evidence
.
(Quality of evidence: very low) Scenario 4: Uric acid-lowering therapy (ULT) 8.
Should HLA-B*5801 testing be performed before allopurinol treatment? ➤Guideline recommendations: Prevalence of HLA-B*5801 alleles is high In the population with high rate (≥5%), it is recommended to test HLA-B*5801 before starting allopurinol
.
(Weak recommendation, quality of evidence: very low) 9.
Is febuxostat superior to allopurinol in the population with high prevalence of HLA-B*5801? ➤Guide recommendations: Among the population with high prevalence of HLA-B*5801, the guide has a neutral opinion on the "pros and cons of febuxostat and allopurinol"
.
(Weak recommendation, quality of evidence: low) 10.
When should ULT be started for newly diagnosed gout patients? ➤Guideline recommendations: For patients who are newly diagnosed with gout and have a blood uric acid level ≥9 mg/dL (536umol/L), it is recommended to start ULT Treatment to prevent the recurrence of gout
.
(Weak recommendation, quality of evidence: very low) Scenario 5: Treatment of chronic gout (CTG) 11.
For CTG patients, should xanthine oxidase inhibitors be used to dissolve tophi? ➤Guideline recommendations: For patients with chronic gout, corresponding It is recommended to use xanthine oxidase inhibitors (allopurinol or febuxostat) to achieve the dissolution of tophi compared to the absence of ULT
.
(Strong recommendation, quality of evidence: low) 12.
In CTG patients who use xanthine oxidase inhibitors but still have persistent hyperuricemia, should lesinurad be added to dissolve tophi? ➤Guide recommendations: In blood uric acid> 6mg /dL (360umol/L) in chronic gout patients, it is not recommended to add lesinurad to xanthine oxidase inhibitor to dissolve tophi
.
(Weak recommendation, quality of evidence: medium) Scenario 6: Refractory gout and treatment non-responding patients 13.
For patients with refractory gout and treatment non-response ➤ Guidelines suggestion: In refractory adult gout patients, except for "lesinurad + other" "Purinol", there is currently no sufficient evidence to prove that other combinations of drugs that promote uric acid excretion and xanthine oxidase inhibitors can lower blood uric acid levels and reduce gout attacks
.
➤Guide recommendations: For adult patients with refractory gout who are contraindicated or who do not respond well to xanthine oxidase inhibitor therapy, pegloticase (if available) is recommended to achieve blood uric acid goals and prevent gout attacks
.
(Weak recommendation, quality of evidence: medium) Scenario 7: Patients with gout and moderate to severe renal impairment 14.
Should patients with gout and renal impairment use ULT to prevent the progression of chronic kidney disease? ➤Guideline recommendations: No support or opposition, not enough at present Evidence recommends or opposes the use of ULT to prevent the progression of chronic kidney disease
.
(Quality of evidence: very low) Scenario 8: Non-pharmaceutical interventions for gout (NPI) 15.
Should alcohol intake be restricted? ➤Guideline recommendations: It is recommended to limit alcohol intake to prevent acute attacks of gout
.
(Weak recommendation, quality of evidence: very low) 16.
Should the intake of purines be restricted? ➤Guide recommendations: No recommendation is not opposed, there is currently insufficient evidence
.
(Quality of evidence: very low) 17.
Should patients be advised to lose weight? ➤Guide recommendations: For overweight/obese gout patients, weight loss interventions are recommended to prevent gout attacks and lower blood uric acid levels
.
(Weak recommendation, quality of evidence: very low) 18.
Can acupuncture be used to relieve acute gout pain? ➤Recommendation of the guidelines: For patients with acute attacks of gout, if they are intolerant or contraindicated with conventional anti-inflammatory drugs, acupuncture may be a kind of The option to relieve pain
.
(Weak recommendation, quality of evidence: very low) 19.
Is it possible to use herbal medicines to prevent gout attacks? ➤Guideline recommendations: no recommendation is not opposed, there is insufficient evidence
.
(Quality of evidence: very low) Guide download: https://guide.
medlive.
cn/guideline/24761 Yimaitong compiled and compiled from: Lorenzo J, Sollano M, Salido EO, et al.
2021 Asia-Pacific League of Associations for Rheumatology clinical practice guideline for treatment of gout[J].
Int J Rheum Dis, 2021.
