Service de rhumatologie, université de Lille, GH de l'institut catholique de Lille, Lille, France; EA4490, physiopathologie des maladies osseuses inflammatoires, université de Lille, Lille, France.
Service de rhumatologie, hôpital Lariboisière, AP-HP, 2, rue Ambroise-Paré, 75010 Paris, France; Inserm U1132 BIOSCAR, université de Paris, Paris, France.
Joint Bone Spine. 2020 Oct;87(5):395-404. doi: 10.1016/j.jbspin.2020.05.002. Epub 2020 May 15.
To develop French Society of Rheumatology-endorsed recommendations for the management of urate-lowering therapy (ULT).
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.
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/1.73m, first-line ULT is allopurinol; in those with eGFR between 30 and 60ml/min/1.73m, allopurinol use must be cautious and febuxostat can be considered as an alternative; and in those whose eGFR is below 30ml/min/1.73m, 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.
These recommendations aim to provide simple and clear guidance for the management of ULT in France.
制定法国风湿病学会认可的降尿酸治疗（ULT）管理建议。
9 位风湿病学家（学术或社区）、3 位全科医生、1 位心脏病专家、1 位肾病学家和 1 位患者使用系统文献检索、1 次起草建议的物理会议和 2 次 Delphi 轮次制定循证推荐意见。
制定了一套 3 项总体原则和 5 项建议。总体原则强调患者教育的重要性，特别是需要解释降低血清尿酸（SU）水平以获得晶体溶解、临床症状消失和避免并发症的目的。一旦确诊痛风，即应开始 ULT。所有痛风患者的 SU 水平必须降至 300μmol/l（50mg/l）以下，或在无法达到 300μmol/l 目标时至少降至 360μmol/l（60ml/l）以下，并必须维持这些目标并终身监测。ULT 的选择主要取决于肾功能：估计肾小球滤过率（eGFR）在 60ml/min/1.73m 以上的患者，一线 ULT 是别嘌醇；eGFR 在 30 至 60ml/min/1.73m 之间的患者，必须谨慎使用别嘌醇并可考虑使用非布司他作为替代；eGFR 低于 30ml/min/1.73m 的患者，必须避免使用别嘌醇并应首选非布司他。预防 ULT 引起的痛风发作涉及逐渐增加 ULT 剂量和至少 6 个月的小剂量秋水仙碱。必须筛查和管理心血管危险因素和疾病、代谢综合征和慢性肾脏病。
这些建议旨在为法国的 ULT 管理提供简单明了的指导。
