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Most patients were comfortable with taking colchicine or taking nonsteroidal anti‐inflammatory drugs (NSAIDs) (Table 1). As soon as he did that, no more wheelchair.”, “I would rather have a shot in the joint, rather than my butt. Elizabeth Park, M.D., of the Columbia University Vagelos College of Physicians and Surgeons in New York City, and colleagues found that the use of hydroxychloroquine (HCQ), a disease-modifying antirheumatic drug (DMARD), did not affect QTc length even when adjusting for critical confounding factors, namely the use of other QTc-prolonging medications. Press Release UCB Showcases Key Rheumatology Data at American College of Rheumatology Convergence 2020 Published: Nov. 5, 2020 at 6:00 p.m. MDedge Rheumatology offers medical news and views, conference coverage, news summaries of journal articles and guidelines, FDA and CDC alerts, CME, and health policy and business of medicine news. The patient panel made no distinction between severe or very severe gout for making this treatment decision. ACR Open Rheumatology is the official open access journal of the American College of Rheumatology. Two patients had been diagnosed with gout while in the hospital and were both given a prescription of allopurinol before hospital discharge, which worked well for them because they had no new gout flares and no perceived prolongation of the current gout flare. Knowledge of patient preferences and values is valuable and was influential for the development of the 2020 ACR gout treatment guideline. 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. I support the active approach. Available for Android and iOS devices. Arthritis & Rheumatism 33:160, 1990) has established general classification guidelines for FM ref 8. The researchers found that adjusted QTc length was comparable between HCQ users and nonusers. ", ACR: Osteoporosis Underdiagnosed, Undertreated in Older Men. Per the authors of the joint replacement guideline, this “drove the direction of the recommendations (uniformly in favor of withholding any medications in which evidence from nonoperative populations suggested an increase in infection) (11).”. The patients with gout who composed the patient panel were identified from the local community via emails to ACR member rheumatologists in academic and private practice in the Birmingham area. In addition, the investigators found an increasing risk for knee or hip replacement surgery with the duration of warfarin use compared with DOAC use. They followed patients aged 40 to 89 years of age with atrial fibrillation on warfarin or DOACs and identified those who had a hip or knee replacement. HCQ remains a safe, effective long-term DMARD for our rheumatic patients. A lay language version of the document was created and provided to patients for their review during the patient meeting discussions (Supplementary Appendix 1). They considered this convenient because the patient is already seeing the doctor (Table 1). Most patients were in favor of taking anti‐inflammatory prophylaxis when starting ULT. I have to start eating the house. [My doctor] would do labs, [i]t wasn’t that inconvenient, would mess up my lunch hour, but it was worth it. If there were a safer alternative that would not affect the kidneys, he would take it. It’s worth it not to have flares in the long run. Dr. Singh has received consulting fees from Crealta/Horizon, Medisys, Fidia, UBM LLC, Trio Health, Medscape, WebMD, Clinical Care Options, Clearview Healthcare Partners, Putnam Associates, Focus Forward, Navigant Consulting, Spherix, Practice Point Communications, the National Institutes of Health, and the American College of Rheumatology (ACR). The patient panel included eight men with gout. The ACR … With the help of a physician moderator, the patient panel reviewed nine key clinical scenarios and the supporting evidence and discussed their views and perspectives related to each. Mild, moderate, and severe gout were defined at the beginning of the discussion as follows: The patient panel group session was led by an experienced moderator (JAS) (15, 25) and lasted 6 hours. The 2020 guideline supplemented their systematic literature reviews with input from patients on their values and preferences regarding the benefits and risks of treatment options. My range of motion was not normal.”, “I had grandma with swollen knuckles because of her gout‐ I don’t want those tophi.”, “I do have that tophi in my elbow now that you are talk about it, I never knew what it was.”, Other concerns: Side effects, inconvenience, “Side effects was a concern for me, it wasn’t to the point of stopping me from taking medications for my gout. The panel indicated that there is less likelihood of the patient starting ULT later, after they have left the doctor’s office or the hospital, and it is beneficial to be on ULT long‐term. Although we selected patient panel members with diversity across disease severity, age, race/ethnicity, and health care receipt from private versus academic rheumatology offices, they are not representative of all patients with gout. One patient with concomitant kidney disease would not take it because he worried about potential kidney side effects. ET 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 American College of Rheumatology (ACR) can Help Combat Insurance Frustrations; Explore This Issue October 2020. I don’t have to call the doctor’s office or remember to ask.”, Clinical scenario 5: Treating to target with active management strategy, “It’s worth it not to have flares in the long run.”, “I support the active approach. Interested patients reached out to the ACR directly with a brief statement of interest and an attestation from their rheumatologist that they had been diagnosed with gout. November 06, 2020 - … Of these eight participants, seven saw a rheumatologist for their gout care and one saw a primary care physician. Our research supports the importance of adequate vitamin K and dependent proteins for limiting progression of osteoarthritis," Ballal said. Dr. Singh serves on the US Food and Drug Administration Arthritis Advisory Committee. The investigators performed a nested, case-control study using the Health Improvement Network, a U.K. general practitioner-based electronic medical record database. The researchers found that Black, Latinx, and Asian patients with rheumatic disease diagnosed with COVID-19 had approximately two to three times higher odds of hospitalization compared with White patients. In addition to comments on specific recommendations, the patient panel feedback on the importance of laboratory and clinical outcomes helped affirm the voting panel’s consideration of the serum urate level as being among the critical outcomes as important as flares and tophi. It always works better when they inject my joint. Patients favored more active urate‐lowering therapy (ULT) management and interventional management of gout flares to achieve desired clinical outcomes, resulting in unanimous consensus on choices related to six clinical scenarios: ULT initiation in gout, treat‐to‐target management strategy, use of pegloticase for refractory gout, starting ULT during a gout flare, using injectable treatments (over oral) for acute gout flares, and use of febuxostat in people with cardiovascular disease. Try watching this video on www.youtube.com, or enable JavaScript if it is disabled in your browser. A patient said, “Mine is mild, but by taking my medication every day; that’s what keeps it mild.” The patient panel acknowledged that the goal of ULT for gout is to eliminate flares and/or tophi to improve overall QOL, which is achieved with ULT (Table 1). "Among hospitalized patients, Latinx patients with rheumatic disease and COVID-19 had three times higher odds of requiring ventilatory support. The panel was in favor of starting ULT during a gout flare. Enter your email address below and we will send you your username, If the address matches an existing account you will receive an email with instructions to retrieve your username. For each question, we first provide the conclusion from the panel followed by main discussion points, noting key exceptions or disagreements with the majority opinion. Fellow in Training Member, Annual Meeting Planning Committee American College of Rheumatology 2017 - 2018 Member Connective Tissue Disease Subspecialty Group, Division of Rheumatology, … Then go slow to help them.”, “Blood test after blood test, then I got to a stable level. A detailed description of both the study and patient participant expectations was provided to these rheumatologists, who shared it with patients they thought would actively participate. This patient panel project was facilitated by the same ACR staff who facilitated the 2020 ACR gout treatment guideline development project, which took place approximately 2 weeks after the patient panel meeting, as well as by a rheumatologist gout guideline voting panel member (JAS). I would rather have a shot in the joint, rather than my butt. Following the ACR guideline methodology to directly involve patients in guideline development, in this qualitative study, a patient panel consisting of patients with varying severity of gout discussed key clinical scenarios related to the management of gout. This was based on their shared experience that during a gout flare, they would do anything to make pain go away (or prevent it from happening). 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. The American College of Rheumatology (ACR) convened the COVID‐19 Clinical Task Force on March 26, 2020, charged by ACR leadership to rapidly provide guidance to rheumatology providers … Optimal management in routine clinical care should use shared decision‐making based on individual patient values, preferences, and clinical status. I went every three months. Some clinical scenarios that were less relevant to patient preference, such as checking the urinary uric acid level prior to prescribing a uricosuric medication for lowering the urate level, were excluded. "Therefore, treatment decisions (i.e., whether to start/stop/modify HCQ therapy) in patients with other risk factors of QT prolongation or coexisting cardiovascular disease, still should be an individualized approach or case-by-case review. ACR staff also provided patients with the same gout guideline evidence report that was provided to the 2020 ACR gout treatment guideline voting panel. E‐mail: Jasvinder.md@gmail.com. A rheumatologist is an internist or pediatrician who received further training in the diagnosis (detection) and treatment of musculoskeletal disease and systemic autoimmune conditions commonly referred to … Patient panel participants consisted of eight men (four who were White and four who were African American). They acknowledged that patients with gout who experience only infrequent flares in the beginning may be less willing to take long‐term medication. Boston University School of Medicine, Boston, Massachusetts, University of California, Los Angeles and Department of Veterans Affairs Greater Los Angeles Healthcare System. TUESDAY, Nov. 17, 2020 -- In the older male population, there is a high level of underdiagnosis and undertreatment of osteoporosis, according to a study presented at ACR Convergence, the annual meeting of the American College of Rheumatology, held virtually from Nov. 5 to 9. Mine is mild, but by taking my medication every day; that’s what keeps it mild.”, “I have mild also, but I believe in keeping my pill on.”, “I do it [take ULT] to reduce the risk of gout flare and the tophi.”, “I think allopurinol is one of the best medicines you can take.”, “It’s a pill you take once a day. A U.S. college student and her boyfriend have been sentenced to four months in prison in the Cayman Islands for violating strict COVID-19 measures following a recent ruling that will be … They started it right away.”, “If you are concerned about your health, you want to take it.”, “If you prescribe me allopurinol during the flare, then I have the medication. All participants received orientation related to the guideline development process and evidence rating at the beginning of the meeting. The lay language summary included the creation/simplification of two choice options for each PICO between A and B, a relevant literature summary synopsis, simple uniform coding for costs with dollar signs ($, $$, $$$), and a simplified system to summarize the risks and benefits of option A versus option B (! Patients valued receiving a ULT prescription at their visit for a gout flare so that ULT could be started right away. 2020 American College of Rheumatology Guideline for the Management of Reproductive Health in Rheumatic and Musculoskeletal Diseases Arthritis Care Res (Hoboken). and you may need to create a new Wiley Online Library account. It really worked for me, when nothing else worked” (Table 1). These guidelines require that widespread … FRIDAY, Nov. 13, 2020 -- Patients with rheumatic disease have a low incidence of COVID-19 and most have mild disease, according to research presented at ACR Convergence, the annual meeting of the American College of Rheumatology, held virtually from Nov. 5 to 9. The funding body did not play any role in in the collection, analysis, and interpretation of data; in the writing of the manuscript; and in the decision to submit the manuscript for publication. Currently housing more than 2,000 images, the ACR Image Library … Patients discussed several scenarios and considered risks (adverse events; patients commonly used the term “side effects”) and benefits of starting a particular drug (to reduce flares) to treat their gout. Several rheumatology organizations have published gout treatment guidelines (3, 4). The patient panel achieved consensus on preferring injectable over oral medications for gout flares because of rapidity of relief and preferred joint rather than intramuscular glucocorticoid injection; all eight patients agreed. A report by one patient of gout exacerbation after an allopurinol dose reduction was greeted with marked disapproval by the rest of the panel for this strategy. I was in the worst pain in my life.”, “When I get the attack, just hit me with a shot‐ it’s so bad.”, Clinical scenario 2: Anti‐inflammatory prophylaxis with ULT initiations, “I would do it every day. Dr. Singh is the editor and the director of the University of Alabama at Birmingham Cochrane Musculoskeletal Group Satellite Center on Network Meta‐Analysis. The format and the design of this project was based on previous ACR patient panel meetings. American College of Rheumatology, Atlanta, GA. 22K likes. Abbreviations: QOL, quality of life; SAE, serious adverse event; sUA, serum urate. 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. The patient panel discussion summary related to several specific questions was also useful because it was reviewed with the 2020 ACR gout guideline voting panel members prior to their discussions and final vote on these same clinical scenarios (see Supplementary Appendix 1). They agreed that if they had moderate or severe gout, they would make dietary changes only if gout cannot be controlled any other way and if that would help prevent gout flares (Table 1). Clinical scenario 6: For a patient on febuxostat who had cardiovascular disease, should they stop or change the drug? It really worked for me, when nothing else worked.”, “This is worth it. We asked them the following question: For what amount of benefit (50% or 90% gout flare or tophi reduction, 50% or 90% improvement in QOL, or 50% or 90% chance of achieving the target serum urate level) will patients accept [X] amount of risk (from 1% to 100%)? These were important discussions that can inform health care providers regarding patient goals and preferences for gout treatment in clinic settings. I have to push the clutch with my cane when I have gout.”, “I couldn’t go to events. I went every three months. ACR: Warfarin Tied to Increased Risk for Knee, Hip Replacement in OA. It is the same with uric acid level and flares. The nurse is standing there by you all the time.”, Clinical scenario 8: Managing gout flares: Oral, systemic injection, joint injection, “I don’t like the needle. Drs. Subscribe to Drugs.com newsletters for the latest medication news, new drug approvals, alerts and updates. They also provided their preference for one of the two treatment options for each clinical scenario. Patients were referred to the project by private and academic rheumatologists in the Birmingham area. When I was younger, I could take any medication.”, “If you are paycheck to paycheck, you are in a different position. The researchers found that warfarin users had a 57 percent increased risk for having a knee replacement or hip replacement compared with DOAC users. Many people continued to consume drinks with high‐fructose corn syrup, such as sodas. I went in a wheelchair to my rheumatologist. Gout is the most common inflammatory arthritis worldwide. Neogi and FitzGerald co‐chaired the ACR’s effort to develop the 2020 gout guideline. The ACR represents more than 7,700 rheumatologists and rheumatology health professionals around the world. The conference featured presentations focusing on the latest advances in the diagnosis and treatment of arthritis as well as other rheumatic and musculoskeletal diseases. However, if an effective alternative with fewer side effects existed, they agreed with changing to that alternative. Most of us know side effects of Aleve, so we are comfortable with it. ACR: Corticosteroid Injections Do Not Speed Progression of Knee OA. However, they realized from personal experience the difficulty in achieving and sustaining weight loss and the possibility that some weight loss diets increase the risk of gout flares. Any queries (other than missing content) should be directed to the corresponding author for the article. The moderator asked the participants if they had any questions and addressed each participant question regarding various aspects of the introduction. Mild: no gout flares in the last year, one occasional flare in the last 5 years, serum urate level controlled, and quality of life (QOL) and functional ability with mild or no impairment, Moderate: one gout flare in the last year, serum urate level elevated, and QOL and functional ability with moderate impairment, Severe: two or more gout flares in the last year, serum urate level very high, multiple visible tophi, and QOL and functional ability severely impaired. The patient panel achieved unanimous consensus on starting ULT during a flare rather than waiting until after the gout flare resolution. 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. I have not had a gout flare since I started it.”, “Allopurinol is affordable for most people.”, “I always wore long sleeves shirt, it [deformity due to tophi] was very embarrassing. 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). Patients were willing to accept more risk for the treatment of tophi. This material is provided for educational purposes only and is not intended for medical advice, diagnosis or treatment. MONDAY, Nov. 16, 2020 -- For adults with atrial fibrillation, warfarin is associated with an increased risk for knee and hip replacements for osteoarthritis, according to a study presented at ACR Convergence, the annual meeting of the American College of Rheumatology, held virtually from Nov. 5 to 9. Dr. Singh previously served as a member of the ACR Annual Meeting Planning Committee and Quality of Care Committee, as the chair of the ACR Meet the Professor/Workshop/Study Group Subcommittee, and as the co‐chair of the ACR Criteria and Response Criteria Subcommittee. 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