recommendations for the management of gout: therapies and prevention claire bombardier, md, frcpc...

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Recommendations for the management of gout:Therapies and Prevention

Claire Bombardier, MD, FRCPCProfessor of Medicine and Rheumatology Division Director, University of Toronto

Senior Scientist, Institute for Work & Health and TGRI, UHN

Rheumatologist, Mount Sinai Hospital

Canada Research Chair and Co-scientific Director, Canadian Arthritis Network

Alison Kydd, MD, PhD, FRCPCClinical Assistant Professor

Division of Rheumatology

University of British Columbia

Ophir Vinik, MD, MSc, FRCPCAdult Rheumatology Resident

University of Toronto

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3e (evidence, exchange, expertise)topics history

1. 2006-2007: Ankylosing Spondylitis

2. 2007-2008: Use of Methotrexate in Rheumatoid Arthritis

3. 2008-2009: How to investigate and follow-up undifferentiated peripheral inflammatory arthritis?

4. 2010- 2011: Pain management by pharmacotherapy in Inflammatory Arthritis

5. 2011-2012:Diagnosis and management of Gout

3

AGREE is an integrated research programme currently funded by the Biomedecine and Health Programme (BIOMED-2) of the European Union.

M Dougados, et al. EULAR standardised operating procedures for the elaboration, evaluation, dissemination, and implementation of recommendations endorsed by the EULAR standing committees. Ann Rheum Dis 2004;63;1172-6.

EULAR and AGREE guidelines

eularMethodology

Topic & questions

Systematic Literature Review

National recommendations

Multinational recommendations

Dissemination

Methodology The methodology used for the development of 3e recommendations is based on the EULAR and AGREE standardised operating procedures for the elaboration, evaluation, dissemination, and implementation of recommendations.

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3e Initiative general methodology

Methodology

Topic & questions

Systematic Literature Review

National recommendations

Multinational recommendations

Dissemination

Methodology

EvidenceSystematic Literature Review

ExpertiseRheumatologists

Recommendations

Exchange

Topic & Questions

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Relevant questions for the topic

Methodology

Topic & questions

Systematic Literature Review

National recommendations

Multinational recommendations

Dissemination

Topic & questions Opening Multinational meeting Proposals made by the national

Steering Committees

Final selection of 10 questionsUsing a modified DELPHI technique, anonymous voting

system…

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Selection of the 10 questionsKickoff meeting – June 24-25, 2011

Proposals made by the national steering committees

Vote session (modified Delphi technique) for the choice of the 10 mutinational questions

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3e initiative 2011-2012

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Multinational level

ChairDésirée van der Heijde

Review and transmission of the SLR results

Methodology

Topic & questions

Systematic Literature Review

National recommendations

Multinational recommendations

Dissemination

Systematic Literature Review Mentors

Daniel AletahaClaire BombardierRachelle BuchbinderLoreto CarmonaChris EdwardsRobert Landewé

Multi-national fellows

Mariano AndrésAlison Kydd John MoiRakhi SethFrancisca Sivera Mascaró Melonie Sriranganathan Caroline van DurmeIrene van EchteldOphir VinicMihir Wechalekar

LibrarianLouise Falzon

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The systematic literature reviewJuly 2011 – March 2012

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10 Questions

5. Alison Kydd

What is the efficacy, cost-efficacy and safety for ULT (allopurinol, but also febuxostat, peg-uricase, benzbromarone and probenecid) in the treatment of gout? Which sequence of ULT or combinations of should be recommended?

10. Ophir Vinik

Can we prevent gouty arthritis, renal disease and CV events by lowering serum uric acid levels in patients with asymptomatic hyperuricaemia? If yes, what should be the target levels?

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The teams

12 PIs

SWEDEN

Anca CATRINA

DENMARK

Mikkel ØSTERGAARD

THE NETHERLANDS

Hans BIJLSMA

AUSTRIA

Burkhard LEEB

GERMANY

Ulf MULLER-LADNER

AUSTRALIA – NEW ZEALAND

Jane ZOCHLING

BRAZIL

Antonio JoséLOPES FERRARI

MEXICO

Rubén BURGOS VARGAS

UNITED KINGDOM

Patrick KIELY

BELGIUM - LUXEMBOURG

Dirk ELEWAUT

PORTUGAL

Jaime BRANCO

ITALY

CarlomaurizioMONTECUCCO

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National recommendations

Methodology

Topic & questions

Systematic Literature Review

National recommendations

Multinational recommendations

Dissemination

National recommendations

13

Closing meeting

Methodology

Topic & questions

Systematic Literature Review

National recommendations

Multinational recommendations

Dissemination

Multinational recommendations

Agreement on one set of multinational

recommendations

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3e Initiative 2011-2012 at a glance

FebruarySeptemberJune March-May June …

KickoffAll participants

June 24-25

Bibliographic Meeting

Only multinational mentors and fellows

September 2-3, Prague

SLR Final results

Available on blogMarch 5

Bibliographic Meeting + PIs

PIs, Mentors and Fellows February 2-4, Lisbon

National meetingsMarch to May

Closing MeetingAll participants

June 22-23, Brussels, Dolce

2011 2012

Dissemination…

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Main Paper presenting the recommendations published in ARDAnn Rheum Dis. 2011 Jan;70(1):15-24. Epub 2010 Aug 19.

Publications: example for UPIA

Supplement of the Journal of Rheumatology entirely dedicated

to 3e UPIA with 11 articlesSupplement 87 published in March 2011

Methodology

Topic & questions

Systematic Literature Review

National recommendations

Multinational recommendations

DisseminationDissemination

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3e Pain Publications

Entire supplement of the Journal of Rheumatology dedicated to 3e Painto be published in early September

8 Cochrane reviews

Main Paper published in Rheumatology online March 2012

EULAR 2011:2 oral communications5 posters

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