Targeting urate levels could help to improve care for people with gout.
Gout is a very common condition, affecting up to 2% of adults in developed countries. The symptoms tend to flare every so often, developing over a few hours and causing severe pain in the joints. It is caused by deposits of crystals of a substance called uric acid (urate) in the joints, which leads to inflammation.
“Treat-to-target” is a strategy that has been used in other diseases to set goals for treatment. It is sometimes shortened to T2T or TTT. Having clear targets for results help doctors to reduce the effects of a disease, and in some diseases may even prevent death. Treat-to-target has been shown to improve care for people with other rheumatic diseases, such as rheumatoid arthritis.
WHAT DID THE AUTHORS HOPE TO FIND?
The quality of care that people with gout receive could be better. The authors hoped to be able to develop treat-to-target recommendations for gout that could help to improve the situation.
WHO WAS STUDIED?
This was a systematic literature search, which means that no new studies of people with gout were
HOW WAS THE STUDY CONDUCTED?
A systematic review aims to identify all the published evidence on a particular topic and draw it together into one summary. The authors used electronic databases to search for the results of studies looking at people with gout, and when adaptation strategies were used to improve the outcomes. The search gave a long list of 761 articles. 55 had the correct type of information and were discussed by a group of experts from North and South America, Europe, Oceania and Asia. The experts included a GP, a rheumatologist, a nephrologist, a cardiologist and a patient.
WHAT WERE THE MAIN FINDINGS OF THE STUDY?
The group agreed on several possible treatment targets for people with gout. These included levels of urate, tophi (small lumps under the skin), pain, the number of joints affected, as well as the prevention of gout attacks. Quality of life and the impact of gout on people’s ability to work were also possible targets. They did not find any randomised trials that used a treat-to-target approach in people with gout.
The experts agreed on four overarching principles. These say that gout can be cured by using uric acid levels as a target. Educating people about their disease is important, and doctors should work with their patients to make decisions together about treatment and make sure that people take their medicine.
There are nine recommendations:
► Levels of urate should be measured regularly and treatment adjusted if needed
► Everyone with gout should try to reduce their urate level to below 6 mg/dL
► In people with very severe gout, serum urate should be reduced even more, to below 5 mg/dL
► Gout attacks should be treated quickly with anti-inflammatory medicines
► Medicines to prevent gout attacks should be used for at least 6 months when taking treatments
to reduce urate levels
► People with gout should have their kidney function checked
► Other diseases that can be linked to gout should be assessed
► People with gout should receive education to help them make lifestyle changes and manage
► Doctors should give people information about their disease
ARE THESE FINDINGS NEW?
The information itself is not new. However, the recommendations that focus on setting a target and adapting treatment to achieve the target is new.
HOW RELIABLE ARE THE FINDINGS?
These recommendations are based on expert opinion.
WHAT DO THE AUTHORS PLAN ON DOING WITH THIS INFORMATION?
The authors hope that this article will be the starting point of a discussion among doctors on how to use a treatto-target approach in the care of people with gout.
WHAT DOES THIS MEAN FOR ME?
If you have gout, your doctor should give you information about the disease. It is important that you are aware of your urate level, and what steps are needed to reach your treatment target. You should also know how to manage a gout attack, and what lifestyle changes you might need to make to feel better. These will depend on your personal circumstances, but could include losing weight, or making
changes to your diet.
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Date prepared: April 2017
Summary based on research article published on: 22 September 2016
From: Kiltz, U. et al. Treat-to-target (T2T) recommendations for gout. Ann Rheum Dis 2017;76:632–638.
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