2020 Recommendations from the French Society of Rheumatology for the management of gout: Management of acute flares |
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| Affiliation: | 1. Service de rhumatologie, hôpital Lariboisière, AP–HP, 2, rue Ambroise-Paré, 75010 Paris, France;2. Inserm U1132 BIOSCAR, université de Paris, Paris, France;3. Service de rhumatologie, université de Lille, GH de l’institut catholique de Lille, Lille, France;4. EA4490, physiopathologie des maladies osseuses inflammatoires, université de Lille, Lille, France;5. Service de rhumatologie, université de Lille, CHU de Lille, Lille, France;6. Faculté de médecine de Rennes, Rennes, France;7. Département de médecine générale, université de Paris, Paris, France;8. Service de cardiologie, hôpital Lariboisière, AP–HP, Paris, France;9. Inserm U942 MASCOT, université de Paris, Paris, France;10. Private practice, Montlignon, France;11. Service de physiologie, hôpital Tenon, AP–HP, Paris, France;12. Inserm U1155, UPMC Université Paris 6, Sorbonne Universités, Paris, France;13. Service de rhumatologie, hôpital Bichat, AP–HP, Paris, France;14. Département de médecine générale, université de Lille, Lille, France;1. Service de Rhumatologie Centre hospitalier Universitaire Saint-Antoine, AP–HP, Sorbonne Université, 184, rue du Faubourg Saint-Antoine, 75012 Paris, France;2. Medical Data & Personalized Health Care Department, Roche, Roche SAS, 92100 Boulogne-Billancourt, France;3. Pipeline Products Strategy Leader in Neurosciences, Roche SAS, 92100 Boulogne-Billancourt, France;4. A+A Agency, 92100 Boulogne-Billancourt, France;5. Medical Data & Personalized Health Care Department, Aixial R&D, on behalf of Roche SAS, Boulogne-Billancourt, France;6. Service de Rhumatologie, Centre hospitalier Universitaire Salengro, Université de Lille, 59037 Lille Cedex, France;1. Department of internal medicine, Fondation A. de Rothschild, 25-29, rue Manin, 75019 Paris, France;2. Department of rheumatology and internal medicine – groupe hospitalier Diaconesses – Croix St-Simon, 125, rue d’Avron, 75020 Paris, France;1. Division of Allergy, Immunology and Rheumatology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan;2. School of Medicine, Tzu Chi University, Hualien, Taiwan;1. Intramural Research Program, National Institutes of Arthritis, Musculoskeletal and Skin Diseases (NIAMS), 10 Center Drive Rm 10N318 Bethesda, Maryland 20892, United States;2. Forefront Dermatology, 8505 Arlington Blvd. Suite 210, Fairfax VA 22031, United States;3. Clinical Trials and Outcomes Branch, Intramural Research Program, National Institutes of Arthritis, Musculoskeletal and Skin Diseases (NIAMS), National Institutes of Health, 10 Center Drive Bethesda, Maryland 20892, United States;1. Université Paris Diderot, UFR de médecine, 75205 Paris cedex 10, France;2. Service de rhumatologie & Inserm UMR 1132 (centre Viggo Petersen), hôpital Lariboisière, AP–HP, 75010 Paris, France |
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| Abstract: | ObjectiveTo develop French Society of Rheumatology-endorsed recommendations for the management of gout flares.MethodsThese 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.ResultsA 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 12 h 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: 1 mg then 0.5 mg one hour later, followed by 0.5 mg , 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.ConclusionThese recommendations aim to provide strategies for the safe use of anti-inflammatory agents, in order to improve the management of gout flares. |
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| Keywords: | Gout Gout flare Colchicine NSAIDs Corticosteroids IL-1 inhibitors |
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