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Objective: 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/1.73m 2 , first-line ULT is allopurinol; in those with eGFR between 30 and 60ml/min/1.73m 2 , allopurinol use must be cautious and febuxostat can be considered as an alternative; and in those whose eGFR is below 30ml/min/1.73m 2 , 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., (Copyright © 2020. Published by Elsevier Masson SAS.)

Objective: 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 12h 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: 1mg then 0.5mg one hour later, followed by 0.5mg,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., (Copyright © 2020. Published by Elsevier Masson SAS.)

Objective: In real life, in a substantial proportion of gouty patients receiving urate-lowering therapy (ULT), urate levels are not maintained below the target of 6.0 mg/dl. We aimed to search for factors associated with poor control of serum uric acid (UA) levels in a large population of patients with gout receiving ULT., Methods: This cross-sectional study involved adults with gout in primary care who were receiving ULT. Demographics, gout history, comorbidities, lifestyle, clinical factors, concomitant treatments, and laboratory data were compared in well-controlled gout (serum UA ≤6.0 mg/dl) versus poorly controlled gout (serum UA >6.0 mg/dl) on univariate and multivariate analyses., Results: Among the 1,995 patients receiving ULT, only 445 (22.3%) had reached the target of 6.0 mg/dl serum UA. Such patients had a lower rate of gout flares within the previous year than patients without the target (mean ± SD 1.7 ± 1.4 versus 2.1 ± 1.4; P < 0.0001). The main factors associated with poor serum UA level control in multivariate analysis were low high-density lipoprotein cholesterol level (adjusted odds ratio [OR] 0.5 [95% confidence interval (95% CI) 0.26-0.96]; P = 0.04), high total cholesterol level (OR 1.83 [95% CI 1.29-2.60]; P = 0.0007), increased waist circumference (OR 1.55 [95% CI 1.11-2.13]; P = 0.008), and alcohol consumption (OR 1.52 [95% CI 1.15-2.00]; P = 0.003)., Conclusion: Dyslipidemia, abdominal obesity, and alcohol consumption are the main factors associated with a poor response to ULT. Knowledge of these factors might help physicians identify cases of gout that may be less likely to achieve target urate level., (© 2017, American College of Rheumatology.)

Objective: To describe the characteristics and management of patients with gout in France during the year 2014., Methods: Data were obtained from a computerized observational longitudinal patient database of a representative sample of 1200 general practitioners. Patients on urate-lowering treatment and/or colchicine were described by demographics and comorbidities, quality of management indicators (serum uric acid and renal function testing) and treatment (type of urate-lowering treatment, change and dose regimen)., Results: We identified 14,400 patients (84.4% men, mean age: 67.5 years) with gout in the database. The most frequent comorbidities were hypertension (70%), dyslipidemia (51%), diabetes (24%) and obesity (23%). The proportion with uric acid and renal function testing data was 32% and 29%, respectively. In gout patients, only 39% had a serum uric acid<6mg/dL. Among treated gout patients, 76% were receiving allopurinol at a mean dose lower than 200mg/d, most without any further change of dose regimen over one year., Conclusion: These data outlined the persistence of clinical inertia in 2014 for patients with gout., (Copyright © 2017 Société française de rhumatologie. Published by Elsevier SAS. All rights reserved.)

Objectives: The allopurinol dose is limited in chronic kidney disease, particularly stage 4/5 chronic kidney disease. Febuxostat has a hepatic metabolism and has been approved without dose adaptation in gouty patients with stage 1-3 chronic kidney disease. We aimed to study the safety and efficacy of febuxostat for stage 4/5 chronic kidney disease., Methods: In this retrospective study, we included patients with (1) a diagnosis of gout, (2) febuxostat treatment, (3) estimated glomerular filtration rate≤30mL/min/1.73m 2 (Modification of Diet in Renal Disease formula) at febuxostat initiation and (4) follow-up for at least 3 months after febuxostat initiation. Efficacy, safety and variation in estimated glomerular filtration rate were analyzed., Results: We included 73 patients (mean age 70.2±11.8, 61 men, 31 with vascular chronic kidney disease and 18 renal transplantation) with gout (baseline serum uric acid level=9.86±2.85mg/dL, mean gout duration 6.2±7.0 years) from 10 academic centers. Comorbidities included cardiac failure (17.8%), hypertension (98.6%), diabetes mellitus (30.1%), dyslipidemia (64.8%) and history of cardiovascular events (38.4%). At the last visit (mean follow-up 68.5±64.8 weeks), the daily dose of febuxostat was 40mg for 7 patients (10.5%), 80mg for 50 (74.6%) and 120mg for 10 (14.9%). Serum uric acid level was<6mg/dL for 49 patients (67%). Renal function improved for 18 patients, was unchanged for 24 and worsened for 31; 19 patients experienced flares and 1 patient, limb edema., Conclusion: Febuxostat seemed efficient in gouty patients with stage 4/5 chronic kidney disease. However, safety data were not clear regarding renal function. Larger studies are needed to assess safety., (Copyright © 2016 Société française de rhumatologie. Published by Elsevier SAS. All rights reserved.)

Objective: To investigate the cutaneous tolerance of febuxostat in gouty patients with skin intolerance to allopurinol., Methods: We identified all gouty patients who had sequentially received allopurinol and febuxostat in the rheumatology departments of 4 university hospitals in France and collected data from hospital files using a predefined protocol. Patients who had not visited the prescribing physician during at least 2 months after febuxostat prescription were excluded. The odds ratio (OR) for skin reaction to febuxostat in patients with a cutaneous reaction to allopurinol versus no reaction was calculated. For estimating the 95% confidence interval (95% CI), we used the usual Wald method and a bootstrap method., Results: In total, 113 gouty patients had sequentially received allopurinol and febuxostat; 12 did not visit the prescribing physician after febuxostat prescription and were excluded. Among 101 patients (86 males, mean age 61±13.9 years), 2/22 (9.1%) with a history of cutaneous reactions to allopurinol showed skin reactions to febuxostat. Two of 79 patients (2.5%) without a skin reaction to allopurinol showed skin intolerance to febuxostat. The ORs were not statistically significant with the usual Wald method (3.85 [95% CI 0.51-29.04]) or bootstrap method (3.86 [95% CI 0.80-18.74])., Conclusion: The risk of skin reaction with febuxostat seems moderately increased in patients with a history of cutaneous adverse events with allopurinol. This moderate increase does not support the cross-reactivity of the two drugs., (Copyright © 2015. Published by Elsevier SAS.)

Objective: To estimate adult gout prevalence in France., Methods: We used a previously established phone questionnaire that allowed for classifying patients as gouty or nongouty by 2 logistic regression models and 1 classification and regression tree (CART) model, the sensitivity and specificity of which were all more than 80%. The full questionnaire was administered by phone to subjects who acknowledged present or past nontraumatic acute pain in a peripheral joint, the others being classified as nongouty. A random sample of adults residing in France was derived from the national telephone directory (home and mobile) by the quota method and further redressed to match the French population. The target size for the interview survey conducted in March and June 2013 was 10,000 participants., Results: We interviewed 10,026 participants. All 3 models (2 logistic regression models and a CART model) converged to an estimated gout prevalence of 0.9%. This prevalence was lower than that estimated by self-reporting only (3.7% [95% confidence interval 3.3-4.1]). The prevalence was higher for men than women and increased with age but did not differ by area of France., Conclusion: Gout prevalence in the adult population of France in 2013 was estimated at 0.9%. Studies using self-reporting only might overestimate the prevalence., (© 2016, American College of Rheumatology.)

Objectives: The reciprocal links between comorbidities and gout are complex. We used cluster analysis to attempt to identify different phenotypes on the basis of comorbidities in a large cohort of patients with gout., Methods: This was a cross-sectional multicentre study of 2763 gout patients conducted from November 2010 to May 2011. Cluster analysis was conducted separately for variables and for observations in patients, measuring proximity between variables and identifying homogeneous subgroups of patients. Variables used in both analyses were hypertension, obesity, diabetes, dyslipidaemia, heart failure, coronary heart disease, renal failure, liver disorders and cancer., Results: Comorbidities were common in this large cohort of patients with gout. Abdominal obesity, hypertension, metabolic syndrome and dyslipidaemia increased with gout duration, even after adjustment for age and sex. Five clusters (C1-C5) were found. Cluster C1 (n=332, 12%) consisted of patients with isolated gout and few comorbidities. In C2 (n=483, 17%), all patients were obese, with a high prevalence of hypertension. C3 (n=664, 24%) had the greatest proportion of patients with type 2 diabetes (75%). In C4 (n=782, 28%), almost all patients presented with dyslipidaemia (98%). Finally, C5 (n=502, 18%) consisted of almost all patients with a history of cardiovascular disease and renal failure, with a high rate of patients receiving diuretics., Conclusions: Cluster analysis of comorbidities in gout allowed us to identify five different clinical phenotypes, which may reflect different pathophysiological processes in gout., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.)

Résumé: La goutte est une pathologie dont la présentation clinique, avec ses différentes phases bien identifiées, prend une part prédominante dans le diagnostic. C’est à partir de ce constat qu’historiquement les différentes classifications diagnostiques, et en premier lieu celles de l’American College of Rheumatology de 1977 et plus récemment de l’EULAR en 2006 ont été élaborées. Dans cette même logique, à partir de la confrontation de ces classifications historiques à une pratique quotidienne et la mise en lumière de leurs limites, de nouvelles classifications comme celle de la Chronic Gout Diagnosis (CGD) ont permis d’affiner les critères diagnostiques notamment cliniques de la pathologie goutteuse. Parallèlement sont apparus des examens morphologiques, au premier rang desquels l’échographie, qui viennent progressivement étayer l’arsenal paraclinique dans l’établissement du diagnostic de goutte, aux côtés de la recherche de microcristaux et de la radiologie conventionnelle. [ABSTRACT FROM AUTHOR]