2020 Recommendations from the French Society of Rheumatology for the management of gout: Management of acute flares - 26/09/20
pages | 7 |
Iconographies | 1 |
Vidéos | 0 |
Autres | 0 |
Highlights |
• | Gout is one of the most common forms of inflammatory arthritis, which remains poorly treated in France and worldwide. |
• | These first French recommendations aim to guide physicians to treat acute flares of gout. |
• | Patient education is critical to treat gout flares at the earliest symptoms. |
• | In gout flares, comorbidities and concurrent medications drive the choice and/or dosage of the anti-inflammatory agent (colchicine, NSAIDs, corticosteroids, IL-1 inhibitor). |
Abstract |
Objective |
To develop French Society of Rheumatology-endorsed recommendations for the management of gout flares.
Methods |
These evidence-based recommendations were developed by 9 rheumatologists (academic or community-based), 3 general practitioners, 1 cardiologist, 1 nephrologist and 1 patient, using a systematic literature search, one physical meeting to draft recommendations and 2 Delphi rounds to finalize them.
Results |
A set of 4 overarching principles and 4 recommendations was elaborated. The overarching principles emphasize the importance of patient education, including the need to auto-medicate for gout flares as early as possible, if possible within the first 12h after the onset, according to a pre-defined treatment. Patients must know that gout is a chronic disease, often requiring urate-lowering therapy in addition to flare treatment. Comorbidities and the risk of drug interaction should be screened carefully in every patient as they may contraindicate some anti-inflammatory treatments. Colchicine must be early prescribed at the following dosage: 1mg then 0.5mg one hour later, followed by 0.5mg,2 to 3 times/day over the next days. In case of diarrhea, which is the first symptom of colchicine poisoning, dosage must be reduced. Colchicine dosage must also be reduced in patients with chronic kidney disease or taking drugs, which interfere with its metabolism. Other first-line treatment options are systemic/intra-articular corticosteroids, or non-steroidal anti-inflammatory agents (NSAIDs). IL-1 inhibitors can be considered as a second-line option in case of failure, intolerance or contraindication to colchicine, corticosteroids and NSAIDs. They are contraindicated in cases of infection and neutrophil blood count should be monitored.
Conclusion |
These recommendations aim to provide strategies for the safe use of anti-inflammatory agents, in order to improve the management of gout flares.
Le texte complet de cet article est disponible en PDF.Keywords : Gout, Gout flare, Colchicine, NSAIDs, Corticosteroids, IL-1 inhibitors
Plan
Vol 87 - N° 5
P. 387-393 - octobre 2020 Retour au numéroBienvenue sur EM-consulte, la référence des professionnels de santé.
L’accès au texte intégral de cet article nécessite un abonnement.
Bienvenue sur EM-consulte, la référence des professionnels de santé.
L’achat d’article à l’unité est indisponible à l’heure actuelle.
Déjà abonné à cette revue ?