L'observance dans l'ostéoporose, le point de vue du médecin généraliste

LILLE2-BU Santé-Recherche (593502101) / SudocSudocFranceF

2020 recommendations from the French Society of Rheumatology for the management of gout: Urate-lowering therapy

International audienceObjective: To develop French Society of Rheumatology-endorsed recommendations for the management of urate-lowering therapy (ULT).Methods: 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 two Delphi rounds to finalize them.Results: A set of 3 overarching principles and 5 recommendations was elaborated. The overarching principles emphasize the importance of patient education, especially the need for explaining the objective of lowering serum urate (SU) level to obtain crystal dissolution, clinical symptoms disappearance and avoidance of complications. ULT is indicated as soon as the diagnosis of gout is established. SU level must be decreased below 300μmol/l (50mg/l) in all gout patients or at least below 360μmol/l (60ml/l) when the 300μmol/l target cannot be reached, and must be maintained at these targets and monitored life-long. The choice of the ULT primarily relies on renal function: in patients whose estimated glomerular filtration rate (eGFR) is above 60ml/min/1.73m2, first-line ULT is allopurinol; in those with eGFR between 30 and 60ml/min/1.73m2, allopurinol use must be cautious and febuxostat can be considered as an alternative; and in those whose eGFR is below 30ml/min/1.73m2, allopurinol must be avoided and febuxostat should be preferred. Prophylaxis of ULT-induced gout flares involves progressive increase of ULT dosage and low-dose colchicine for at least 6 months. Cardiovascular risk factors and diseases, the metabolic syndrome and chronic kidney disease must be screened and managed.Conclusion: These recommendations aim to provide simple and clear guidance for the management of ULT in France

2020 Recommendations from the French Society of Rheumatology for the management of gout: Management of acute flares

International audienceObjective:To develop French Society of Rheumatology-endorsed recommendations for the management of gout flares.Methods:These 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.Results:A 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.Conclusion:These recommendations aim to provide strategies for the safe use of anti-inflammatory agents, in order to improve the management of gout flares

Recommandations 2020 de la Société française de rhumatologie pour la prise en charge de la goutte : traitement des crises de goutte

National audienceObjectif :Élaborer les recommandations de la Société française de rhumatologie pour la prise en charge des crises de goutte.Méthodes :Ces recommandations ont été élaborées par 9 rhumatologues (hospitaliers ou libéraux), 3 généralistes, 1 cardiologue, 1 néphrologue et 1 patient, sur la base d’une revue systématique de la littérature.Résultats :Quatre principes généraux et 4 recommandations ont été établis. Les principes généraux soulignent l’importance de l’éducation du patient, et du traitement précoce des crises de goutte, si possible dans les 12 premières heures, selon un traitement pré-défini. Les patients doivent savoir que la goutte est une maladie chronique qui nécessite un traitement hypo-uricémiant en sus du traitement de la crise. Les comorbidités et les possibles interactions médicamenteuses, qui peuvent contre-indiquer certains traitements anti-inflammatoires, doivent être recherchées avec soin chez tous les patients. La colchicine doit être prescrite à la dose suivante : 1 mg puis 0,5 mg une heure plus tard, puis 0,5 mg deux à trois fois par jour les jours suivants. La diarrhée est le premier symptôme d’intoxication à la colchicine, et doit faire diminuer les posologies. La posologie de la colchicine doit également être diminuée chez les patients présentant une insuffisance rénale chronique ou prenant des médicaments qui interagissent avec son métabolisme. Les autres options de première ligne sont les corticoïdes (oraux ou intra-articulaires), les anti-inflammatoires non stéroïdiens (AINS). Les anti-IL-1 sont un traitement de seconde ligne, en cas d’échec, intolérance ou contre-indication à la colchicine, aux corticoïdes ou aux AINS. Ils sont contre-indiqués en cas d’infection et doivent faire surveiller les polynucléaires neutrophiles.Conclusion :Ces recommandations proposent des stratégies d’utilisation des anti-inflammatoires pour une meilleure prise en charge des crises de goutte