The panel was in favor of starting ULT during a gout flare. The inconvenience of frequent laboratory testing for titration was discussed; most patients understood the reason and were comfortable with it (Table 1). Several rheumatology organizations have published gout treatment guidelines (3, 4). I would rather have a shot in the joint, rather than my butt. The ACR staff and panel moderator had expertise in guideline development and GRADE methodology. Then, I had a gout attack in my elbow and wrist on the same side. It’s better to have something in your body when you are in a flare.”, “My gout ‐ this was discovered when I was in the hospital for different reason. The authors evaluated data from the COVID-19 Global Rheumatology Alliance Provider survey (launched late March 2020), analyzing details for more than 1,300 patients with rheumatic disease in the United States diagnosed with COVID-19. This highlights that risk averseness of patients related to medication use is similar to that demonstrated for other chronic conditions and long‐term medications and in other guideline patient panels (10, 12). If you didn’t have insurance, maybe it costs a lot more.”. Most patients were in favor of taking anti‐inflammatory prophylaxis when starting ULT. The annual meeting of the American College of Rheumatology was held virtually this year from Nov. 5 to 9 and attracted participants from around the world, including rheumatology specialists, … "Further studies examining interventions to reduce disparities will help shed light on ways we can improve the health of all patients diagnosed with rheumatic disease, especially those who experience inequitable outcomes.". Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. ET The patient panel favored more active management, preferring a treat‐to‐target management strategy (despite increased laboratory testing or provider visits), pegloticase for patients with severe manifestations of gout, and joint injections over oral medications for gout flares. and you may need to create a new Wiley Online Library account. Address correspondence to Jasvinder A. Singh, MBBS, MPH, The University of Alabama at Birmingham, Faculty Office Tower 805B, 510 20th Street South, Birmingham, AL 35294. Because this was a single‐center study with only eight patients, the generalizability of these findings beyond the scope of the original intent are limited. For the two patients supporting fixed‐dose initiation, both had started allopurinol at 300 mg daily, with good results and no adverse events. The session started with brief introductions of all participants, who were seated in a conference room with a U‐shaped seating arrangement. The panel was also in agreement about using oral medications at home to prevent and abort gout flares early as well as using intramuscular injections for more severe flares (no vote for this statement). Patient panel participants discussed their perspectives regarding the choices and what factored into their choices and why. Our study results should be interpreted while considering study limitations. The annual meeting of the American College of Rheumatology was held virtually this year from Nov. 5 to 9 and attracted participants from around the world, including rheumatology specialists, physicians, scientists, and other health professionals. Within one hour of getting colchicine, I felt better and it all resolved in three days.”, Clinical scenario 9: Lifestyle modifications: Diet change, “Absolutely. The format and the design of this project was based on previous ACR patient panel meetings. The results of this study will be presented by Michael George, M.D., of the University of Pennsylvania during the annual meeting of the American College of Rheumatology … What More Can Congress do to Support Rheumatology Providers? The patient panel also achieved consensus on treat to target with a more active management strategy than a fixed strategy. In the absence of such work, there is a risk of formulating potentially meaningless recommendations for ULT use and/or recommendations that are paternalistic and that may not account for factors that may be weighed differently between patients and health care providers. However, some had curtailed their occasional beer drinking because of the risk of gout flares. It’s [ibuprofen] over the counter, I would walk down to the convenient store.”, “You are talking about Aleve. Learn about our remote access options, Birmingham Department of Veterans Affairs Medical Center and The University of Alabama at Birmingham. [Original Research], Nurse‐led care is preferred over GP‐led care of gout and improves gout outcomes: results of Nottingham Gout Treatment Trial follow‐up study, Facilitators and barriers to adherence to urate‐lowering therapy in African‐Americans with gout: a qualitative study, Patient perceptions of gout management goals: a cross‐sectional internet survey, A cross‐sectional internet‐based patient survey of the management strategies for gout, The direct economic burden of gout in an elderly canadian population, A systematic review of the economic and humanistic burden of gout, Patients' knowledge and beliefs concerning gout and its treatment: a population based study, Patients and providers view gout differently: a qualitative study, The dynamics of chronic gout treatment: medication gaps and return to therapy, Adherence with urate‐lowering therapies for the treatment of gout, The impact of gout on patient's lives: a study of African‐American and Caucasian men and women with gout, https://www.nationalacademies.org/our‐work/standards‐for‐developing‐trustworthy‐clinical‐practice‐guidelines, http://www.g‐i‐n.net/working‐groups/gin‐public/toolkit, https://www.agreetrust.org/wp‐content/uploads/2013/12/AGREE‐II‐GRS‐Instument.pdf, Clinical scenario 1: Starting ULT for gout, “I was just treating symptoms and I thought I was fine.”, “Mine kind of started that way, mild. The primary outcome measure was QTc length and the primary predictor was HCQ use, adjusted for several covariates, including RA and SLE disease factors, cardiovascular risk factors, and other QTc-prolonging medications. I didn’t want daily medication.”, “Mild is not the worry; several of us are mild now. They acknowledged that patients with gout who experience only infrequent flares in the beginning may be less willing to take long‐term medication. I don’t like the needle. However, because of time constraints, we were unable to assess all the clinical scenarios that were voted on by the gout guideline voting panel. The American College of Rheumatology Provisional Composite Response Index for Clinical Trials in Early Diffuse Cutaneous Systemic Sclerosis Arthritis Rheumatol . E‐mail: Jasvinder.email@example.com. ACR Open Rheumatology is the official open access journal of the American College of Rheumatology. They also provided their preference for one of the two treatment options for each clinical scenario. Of these eight participants, seven saw a rheumatologist for their gout care and one saw a primary care physician. Drugs.com provides accurate and independent information on more than 24,000 prescription drugs, over-the-counter medicines and natural products. The American College of Rheumatology (ACR) has published its 2020 update to the gout treatment guideline, reinforcing treat‐to‐target paradigms that should improve the quality of gout care (5). The annual meeting of the American College of Rheumatology was held virtually this year from Nov. 5 to 9 and attracted participants from around the world, including rheumatology specialists, … These were important discussions that can inform health care providers regarding patient goals and preferences for gout treatment in clinic settings. "Among hospitalized patients, Latinx patients with rheumatic disease and COVID-19 had three times higher odds of requiring ventilatory support. For a 50% or a 90% higher chance of achieving a target serum urate level, patients would accept low‐medium risk of SAEs (Table 2). Whereas some panel members were comfortable with a 6‐month duration of prophylaxis, others questioned the value beyond 3 months, and wanted to see the evidence of use for 3‐ versus 6‐months. The moderator reviewed the ACR evidence‐based guideline development process, including the purpose of guideline development, the development and interpretation of the evidence synthesis, the quality of evidence rating using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology, and the purpose of the patient panel meeting. American College of Rheumatology, Atlanta, GA. 22K likes. Patients were willing to accept more risk for the treatment of tophi. 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