菲律宾痛风临床治疗指南.pdf

Philippine Clinical Practice Guidelines for the Management of GoutTechnical Review Committee Members: Li-Yu J1, Salido EO2, Manahan S3, Lichauco JJ4, Lorenzo JP3, Torralba KT5, Raso AA6, Roberto LC6, Santos Estrella P4, Maceda LM7in behalf of the Philippine Rheumatology Association1Assistant Professor, Faculty of Medicine and Surgery, University of Santo Tomas, Philippines2Clinical Associate Professor, University of the Philippines College of Medicine, Philippines3Section of Rheumatology, Department of Medicine, University of the Philippines, Philippines4Assistant Professor, St. Luke’s College of Medicine-William H. Quasha Memorial, St. Luke’s Medical Center, Philippines5Assistant Professor, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA6Section of Rheumatology, Clinical Immunology, and Osteoporosis, Department of Medicine, University of Santo Tomas, Philippines7Section of Rheumatology, Department of Medicine, St. Luke’s Medical Center, PhilippinesPanel:Arroyo C (PRA), Barba M (PRA), Lucero A (PRA), Saguil-Sy R (PRA), Torralba TP (PRA), Alvarez V (PSHP), Calalay E (patient), De Castro J (PARM) Dimacali CL (PSN), Feliciano E (NDAP), Fojas M (PSEM), Joves P (PAFP), Reyes E (PHA/PCP), Vinluan RM (DOH)Address correspondence to: Julie Li-Yu, MD, Philippine Rheumatology Association Rm 1408 Cathedral Heights Bldg Complex, St. Luke’s Medical Center, E. Rodriguez Sr. Avenue, Quezon City 1002, Email: pra@.ph; PRA Contact number: (+632) 726 8875Email: julieliyu@tri-Keywords : practice guidelines, gouty arthritisDisclosuresJLY serves as consultant to Novartis and trial investigator for Pfizer. EOS and JJL serve as trial investigators for Pfizer. Other members of TRC have nothing to disclose. AcknowledgmentThe Steering Committee would like to thank Dr. H Ralph Schumacher Jr for providing helpfulcomments on the contents. AbstractObjective: Gout is the most prevalent form of arthritis afflicting Filipinos. The diagnosis and overall management need further improvement especially among medical practitioners. Our study aims to develop evidence-based guidelines for general medical practitioners on the management of uncomplicated gout with the overall goal of improving the standard of care of patients with gouty arthritis.Methodology: The Technical Review Committee (TRC) of the Philippine Rheumatology Association (PRA) Gout Special Interest Group (SIG) conducted a literature search relating to management issues on all phases of gout from years 1980 to 2007 using databases including Medline, Ovid, Lilacs, Cochrane Central Register of Controlled Trials (CENTRAL). TheGRADE system in rating quality of evidence and strength of recommendation was used. A multidisciplinary panel voted and approved the final recommendations during an en banc meeting. Results: Nine recommendations for the management of uncomplicated gouty arthritis were developed based on evidence from the literature and consensus among experts and key stakeholders. Concerns regarding the initiation and maintainance of urate lowering therapy, target serum uric acid levels, treatment of acute gout, lifestyle and dietary modifications, comorbidities associated with gout such as cardiovascular disease were addressed. INTRODUCTIONGout is the most prevalent form of arthritis among the Filipinos. The prevalence of gout is 1.6% (1), a distinctive uptrend compared to 1991 when the prevalence was 0.5% (2), and in 1997 when the prevalence was 0.13% (3). Despite known quality indicators for treatment of gout (4), there is poor adherence of physicians to these indicators (5). Interestingly,inappropriate management of gout is a frequent occurrence even with physician consultation(6). The Philippine Rheumatology Association (PRA) sought to establish evidence-based guidelines with the goal of improving the standards of care for patients with gout. It is intended to assist medical care providers in making decisions on the care of these patients based on the best available evidence. Guidelines were specifically sought to address the following issues: to assess the role, safety and effectiveness of available therapies including colchicine, corticosteroids, allopurinol; to establish the role of non-pharmacologic measures including dietary modification, alcohol cessation, ice compress; to define the importance of addressing hyperuricemia; to address the role of other hypouricemic agents such as losartan and fenofibrate; to emphasize cardiovascular and renal co-morbidities associated withuncontrolled gout and hyperuricemia.Issues related to the diagnosis of gout and management of complicated cases of gout are not included in this guideline. The full-length text of the guidelines can soon be found on www.philippinerheumatology.org.METHODOLOGYThe PRA Gout Steering Committee convened a technical review committee to search for and grade the available evidence related to the management of all phases of gout. A search for studies publishe。