[90 references] PubMed, The type of supporting evidence is identified and graded for each recommendation (see the "Major Recommendations" field.). Add a note. Recommendation 21: In patients with CKD and gout the use of colchicine for prophylaxis of new attacks can be assessed using the SmPC (LE 2b; GR B). Both probenecid and sulfinpyrazone are not available in Spain, so they must be requested as special drugs (LE 3a; GR C). Recommendation 56: Evaluation of response to urate-lowering treatment may be made based on a number of variables, including: frequency of acute attacks, serum uric acid levels, presence and number of MSU crystals in synovial fluid, and number and size of tophi (LE 5; GR D). During the development of the guidelines quality criteria of the Appraisal of Guidelines for Research and Evaluation (AGREE) instrument have been taken into account. Pegloticase could be requested for use as a drug not licensed in Spain (LE 4; GR C). Madrid (Spain): Spanish Society of Rheumatology (SER); 2013. Guidelines represented on the NGC Web site are submitted by guideline developers, and are screened solely to determine that they meet the NGC Inclusion Criteria which may be found at http://www.guideline.gov/about/inclusion-criteria.aspx. Under this contract, and even being responsible for funding the project, the pharmaceutical company has had no ability to influence the content of the guidelines, even assuming that the evidence contradicted the indication of any of its products. Recommendation 22: In patients with mild/moderate CKD and gout the uricosuric drug of choice is benzbromarone at doses of 50–200 mg/day (LE 1b; GR A). Non-steroidal anti-inflammatory drug (NSAID) use is contraindicated in the control of acute attacks and preventing their recurrence because they increase the risk of acute and chronic kidney damage. Recommendation 39: Although the gold standard for the diagnosis of gout is the visualization of crystals, in patients with typical symptoms such as intermittent arthritis with complete resolution at the first metatarsophalangeal (MTP) joint (podagra) in the presence of prior hyperuricaemia, clinical diagnosis may be a reasonable alternative for the primary care (PC) doctor up to definitive diagnosis (LE 5; GR D). 24. Recommendation 60: In acute gout attacks corticosteroids are recommended for patients with contraindications to NSAIDs/COXIBs. or cytochrome P450 (CYP)3A4 inhibitors (protease inhibitors, macrolides, antifungals, etc.). Azathioprine is metabolized by xanthine oxidase which, in turn, is inhibited by allopurinol and febuxostat. We would like to show you a description here but the site won’t allow us. The most frequent adverse effects associated with pharmacologic treatment of gout are summarized in Table 25 in the original guideline document. The other review examined the evidence base for treating patients with acute gout attacksin the primary care setting. This patient information has been derived and prepared from a guideline for health care professionals included on NGC by the authors or publishers of that original guideline. Recommendation 53: Treatment for the prevention of acute episodes of inflammation should always be prescribed unless contraindicated, at least during the first six months of urate-lowering treatment (LE 2b; GR B). They could be considered in conditions other than those authorized – canakinumab and anakinra – or as a drug not licensed in Spain – rilonacept – in acute episodes of refractory inflammation or for prophylaxis when other approved therapeutic options cannot be used in patients with severe gout, specifically with chronic inflammation or very frequent acute episodes of inflammation (LE 1b; GR B). Spanish Society of Rheumatology (SER). Furthermore, caution should be exercised with the combination of colchicine and other less potent CYP3A4 inhibitors, such as statins and other lipid-lowering agents. Therefore, if they are chosen, it is recommended to request authorization for their off-label prescription use (LE 4; GR C). Get information to help you prepare your practice, counsel your patients and administer the vaccine. – US Government Rights. Prepare for the ABFM exam with the AAFP’s Family Medicine Board Review Express Livestream, February 18-21 and get the same in-depth Board review but with all the conveniences of your home or office. , approve, or low-dose colchicine should be prescribed for patients who have gout! Personalized experience when using the guideline developer on July 22, 2014 the site won t! Lyell 's syndrome, in Europe access a summary of the questions agreed upon the. Used solely to provide specific medical advice for particular patients therapy with azathioprine or 6-mercaptopurine to. 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