Gout and Hyperuricemia: New Guidelines and Treatments

2008 ◽  
Vol 22 (1) ◽  
pp. 104-115
Author(s):  
Geoffrey C. Wall ◽  
Sarah A. Cooper
Keyword(s):  
Inflammatory Arthritis ◽  
Evidence Based ◽  
Randomized Controlled ◽  
Randomized Controlled Studies ◽  
European League Against Rheumatism ◽  
Acute Attacks ◽  
New Guidelines ◽  
Evidence Based Guidelines ◽  
New Compounds ◽  
European League

Gout is the most common inflammatory arthritis in western countries and the incidence is increasing. Additionally, evidence now exists that cases of severe, refractory gout seem to be increasing. The management of gout and hyperuricemia has remained largely unchanged for decades and includes antiinflammatories used initially for acute attacks and primarily allopurinol to prevent future attacks. Evidence-based guidance for the management of gout and hyperuricemia has been plagued by a lack of randomized, controlled studies and the lack of new medications. Recently evidence-based guidelines by the European League Against Rheumatism were published; one of the first attempts by a major medical body to assess the state of gout and hyperuricemia treatment. Additionally, several new compounds seem poised to be released for hyperuricemia treatment. This review details the important aspects of the gout guidelines relating to pharmacotherapy and critically examines the data surrounding new modalities to decrease serum uric acid.

scholarly journals Ergebnisse der systematischen Literatursuche als Grundlage für die „evidenzbasierten Therapieempfehlungen für FMF-Patienten mit unzureichendem Ansprechen bzw. Unverträglichkeit auf Kolchizin“ der Gesellschaft für Kinder- und Jugendrheumatologie und der Deutschen Gesellschaft für Rheumatologie

2020 ◽  
Vol 79 (9) ◽  
pp. 943-951
Author(s):  
T. Sahr ◽  
U. Kiltz ◽  
C. Weseloh ◽  
T. Kallinich ◽  
J. Braun
Keyword(s):  
Evidence Based Medicine ◽  
Deutsche Gesellschaft ◽  
Evidence Based ◽  
Kontrollierte Studien ◽  
European League Against Rheumatism ◽  
Sind Eine ◽  
Based Medicine ◽  
European League

Zusammenfassung Hintergrund Das familiäre Mittelmeerfieber (FMF) ist eine in Deutschland eher seltene genetisch bedingte Erkrankung des Kindes- und Erwachsenenalters, die durch rezidivierende Fieberschübe sowie Peritonitis, Pleuritis und Arthritis charakterisiert ist. Die etablierte Therapie mit Kolchizin ist für die meisten Patienten wirksam und verträglich. Einige Patienten sprechen aber auf diese Therapie nicht ausreichend an bzw. vertragen diese nicht. Für diese Patienten kommen Biologika in Betracht. Die Gesellschaft für Kinder- und Jugendrheumatologie (GKJR) und die Deutsche Gesellschaft für Rheumatologie (DGRh) sind übereingekommen, gemeinsame Empfehlungen für diese spezielle klinische Situation zu entwickeln. Ziel Durchführung einer systematischen Literaturrecherche (SLR) auf Basis der 2016 publizierten EULAR(European League Against Rheumatism)-Empfehlungen als Grundlage für die Entwicklung von evidenzbasierten Therapieempfehlungen für FMF-Patienten mit unzureichendem Ansprechen bzw. Unverträglichkeit auf Kolchizin. Methoden Die SLR wurde mit Referenzen aus verschiedenen Datenbanken und als Aktualisierung der bis zum Jahr 2014 durchgeführten SLR der EULAR durchgeführt, wobei die Artikel zwischen dem 01.01.2015 und dem 31.12.2017 publiziert worden sein mussten. Für die Vorselektion wurde das Abstractwerkzeug Rayyan und für die Erstellung der Evidenztabellen die Klassifikation des Oxford Centre for Evidence Based Medicine 2009 benutzt. Ergebnisse Die Suche ergab 360, nach Dublettenabgleich noch 263 Treffer. Insgesamt 88 Publikationen wurden ein- (34%) und 102 ausgeschlossen (39%), bei weiteren 73 war eine Sichtung der Vollpublikation notwendig (28%), und 43 wurden intensiver diskutiert. Schlussendlich blieben 64 Publikationen (24%) übrig. Insgesamt wurden 4 Fall-Kontroll-Studien, 31 Kohortenstudien, 8 Fallserien, 7 kontrollierte Studien (davon 5 Abstracts), 10 Übersichtsarbeiten sowie 4 Metaanalysen und systematische Reviews akzeptiert. Diskussion Die SLR wurde wissenschaftlich exakt, transparent und nach internationalen Standards durchgeführt. Die SLR erwies sich als gute Grundlage für die Konsentierung der 5 übergeordneten Prinzipien und der 10 Empfehlungen, sodass die gemeinsame Aktivität von GKJR und DGRh erfolgreich und sogar zeitnah abgeschlossen werden konnte. Die Empfehlungen sind eine solide Basis, Patienten jeden Alters mit FMF gut zu behandeln. Dabei spielen die Erklärungen zum Problem der Kolchizinresistenz eine wichtige Rolle.

Developing the evidence base for the new guidelines for reduction of cardiovascular risk for children by the National Heart, Lung, and Blood Institute

2011 ◽  
Vol 21 (S2) ◽  
pp. 165-168
Author(s):  
Samuel S. Gidding
Keyword(s):  
Cardiovascular Risk ◽  
Evidence Base ◽  
Evidence Based ◽  
Blood Institute ◽  
National Heart ◽  
Congenital Cardiac Disease ◽  
National Heart Lung ◽  
New Guidelines ◽  
Evidenced Based ◽  
Evidence Based Guidelines

AbstractIn 2006, a process was initiated to develop evidence-based paediatric guidelines directed towards physicians for reduction of cardiovascular risk. In contrast to prior consensus-based guidelines from the National Heart, Lung, and Blood Institute, this process was to be evidenced based. This manuscript describes the process undertaken to write the evidence-based guidelines from the National Heart, Lung, and Blood Institute, beginning with the search for evidence, then the process of review of the evidence, and finally the writing of the final document. This manuscript also provides some thoughts on how this process might be adapted in developing guidelines for caring for patients with congenital cardiac disease.

scholarly journals Evaluation of Pancreatotropic and Joint Efficiency of Intracellular Systemic Enzyme in Osteoarthritis

2021 ◽  
pp. 66-69
Author(s):  
Liliia Babynets ◽  
Iryna Halabitska
Keyword(s):  
Objective Assessment ◽  
Pancreatic Insufficiency ◽  
Study Groups ◽  
Exocrine Pancreatic Insufficiency ◽  
Evidence Based ◽  
Unresolved Issue ◽  
Orthopedic Surgeons ◽  
European League Against Rheumatism ◽  
Based Medicine ◽  
European League

Despite the advances of modern evidence-based medicine, the treatment of osteoarthritis (OA) remains a complex and unresolved issue. Of course, modification of the patient’s lifestyle improves the condition of a patient with osteoarthritis, but the management of a patient with osteoarthritis without drug therapy, which is mostly symptomatic, is almost impossible. The objective: was to investigate the effectiveness of intracellular systemic enzyme in the complex therapy of patients with primary OA in comorbidity with exocrine pancreatic insufficiency for the correction of pathological processes developing in patients. Materials and methods. 69 patients with primary OA in comorbidity with exocrine pancreatic insufficiency were examined. The diagnosis of OA was established on the basis of diagnostic criteria of the American College of Rheumatologists (ACR, 2018), the European Association of Rheumatologists (European League Against Rheumatism, EULAR, 2018). American Academy of Orthopedic Surgeons (AAOS, 2018), International Society for the Study of OA (OARSI, 2019). Examination of the joints included examination, palpation, and objective assessment of pain. OA symptoms were also assessed by Leken index and the Harris test. To assess the state of exocrine pancreatic insufficiency, the content of fecal α-elastase was determined and the coprogram was evaluated. Patients were divided into two groups: the 1st group received treatment of primary OA according to international recommendations, the 2nd group additionally received an enzymatic drug. Results. After the treatment, patients of the 1st group showed a statistically significant tendency to deterioration of fecal α-elastase and coprogram (p<0,05), in the 2nd group there was a statistically significant improvement of these indicators (p<0,05). There was also a statistically significant improvement in the course of primary OA in both study groups (p<0,05), but in the 2nd group the therapeutic effect was statistically significantly more significant (p<0,05). Conclusions. There was a statistically significant positive dynamics of exocrine pancreatic insufficiency and course of primary OA in the 2nd group compared to those in the 1st after treatment (p<0,05), which indicates the feasibility of using the enzyme drug in the treatment of patients with primary OA in comorbidity with exocrine pancreatic insufficiency.

scholarly journals Postoperative controls of ventilation tubes in children - by general practitioner or otolaryngologist? Study protocol for a multicenter, randomized, controlled trial (The ConVenTu study)

2020 ◽  
Author(s):  
Bjarne Austad ◽  
Ann Helen Nilsen ◽  
Anne-Sofie Helvik ◽  
Grethe Albrektsen ◽  
Ståle Nordgård ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Tympanic Membrane ◽  
Postoperative Care ◽  
Controlled Trial ◽  
Evidence Based ◽  
Randomized Controlled ◽  
Multicenter Randomized Controlled Trial ◽  
Ventilation Tubes ◽  
Regional Health Authorities ◽  
Evidence Based Guidelines

Abstract Background Insertion of ventilation tubes (VTs) in the tympanic membrane is one of the most common ambulatory surgeries performed on children. Postoperative care may continue for two or more years and is today mostly done by otolaryngologists. Controls by general practitioners (GPs) may represent a sufficient level of health care regarding clinical outcome, but there exist no evidence-based guidelines concerning the level of expertise for this task. Aim To evaluate whether postoperative care after surgery with VTs performed by GPs represent a sufficient alternative to otolaryngologists. Methods/design Randomized controlled trial including patients from seven hospitals in all four Regional Health Authorities in Norway. A total of 400 children aged 3-10 years will be randomized to postoperative care by either otolaryngologist or their regular GP after surgery with VTs in the tympanic membrane. Two years after surgery we will compare hearing thresholds, middle ear function, complication rate, health related quality of life as well as the guardians’ evaluations of the postoperative care. Discussion Results from the ConVenTu study are expected to contribute with knowledge necessary to develop evidence-based guidelines regarding the level of expertise for safe postoperative care for children after surgery with VTs.

scholarly journals Towards a new model for producing evidence-based guidelines: a qualitative study of current approaches and opportunities for innovation among Australian guideline developers

F1000Research ◽  
2019 ◽  
Vol 8 ◽  
pp. 956
Author(s):  
Steve McDonald ◽  
Julian H. Elliott ◽  
Sally Green ◽  
Tari Turner
Keyword(s):  
Systematic Reviews ◽  
New Technologies ◽  
Research Output ◽  
Guideline Development ◽  
Evidence Based ◽  
Structured Interviews ◽  
Australian Guideline ◽  
Horizon Scanning ◽  
New Guidelines ◽  
Evidence Based Guidelines

Background: Many organisations in Australia undertake systematic reviews to inform development of evidence-based guidelines or would like to do so. However, the substantial resources required to produce systematic reviews limit the feasibility of evidence-based approaches to guideline development. We are working with Australian guideline developers to design, build and test systems that make creating evidence-based guidelines easier and more efficient. Methods: To understand the evidence needs of guideline developers and to inform the development of potential tools and services, we conducted 16 semi-structured interviews with Australian guideline developers. Developers were involved in different types of guidelines, represented both new and established guideline groups, and had access to widely different levels of resources. Results: All guideline developers recognised the importance of having access to timely evidence to support their processes, but were frequently overwhelmed by the scale of this task. Groups developing new guidelines often underestimated the time, expertise and work involved in completing searching and screening. Many were grappling with the challenge of updating and were keen to explore alternatives to the blanket updating of the full guideline. Horizon-scanning and evidence signalling were seen as providing more pragmatic approaches to updating, although some were wary of challenges posed by receiving evidence on a too-frequent basis. Respondents were aware that new technologies, such as machine learning, offered potentially large time and resource savings. Conclusions: As well as the constant challenge of managing financial constraints, Australian guideline developers seeking to develop clinical guidelines face several critical challenges. These include acquiring appropriate methodological expertise, investing in information technology, coping with the proliferation of research output, feasible publication and dissemination options, and keeping guidance up to date.

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