To accomplish this second NMA, we grouped similar agents into nodes (e.g., acetic acid derivatives, profens, cyclooxygenase 2 agents, glucocorticoids, and interleukin‐1 [IL‐1] inhibitors). Faculty of Radiologists Equality and Diversity Policy. The following articles provide helpful advice on the entire scientific communication process, from writing the abstract to delivering the poster or oral presentation. Learn about our remote access options, University of California, Los Angeles and VA Greater Los Angeles Health Care System, Los Angeles, California, University of Auckland, Auckland, New Zealand, University of Nebraska Medical Center and VA Nebraska–Western Iowa Health Care System, Omaha, Nebraska, McMaster University, Hamilton, Ontario, Canada, New York University School of Medicine, New York City, New York, Johns Hopkins University, Baltimore, Maryland, University of Massachusetts Medical School, Worcester Massachusetts, and Corrona, Waltham, Massachusetts, Boston University School of Medicine, Boston, Massachusetts, VA Boston Healthcare System, Boston, Massachusetts, University of Alabama at Birmingham and Birmingham Veterans Affairs Medical Center, Birmingham, Florida State University College of Medicine School of Physician Assistant Practice, Tallahassee, University of Michigan, VA Ann Arbor Healthcare System, Ann Arbor, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, US Department of Veterans Affairs, Manchester, New Hampshire, Mount Auburn Hospital, Cambridge, Massachusetts, Allegheny Health Network, Pittsburgh, Pennsylvania, American College of Rheumatology, Atlanta, Georgia. Medications noted above are known to have effects on SU concentrations 110. While the etiology of gout is well‐understood and there are effective and inexpensive medications to treat gout, gaps in quality of care persist 2-4. A series of cases should be used to illustrate the topic being presented. Data from more recent RCTs comparing treat‐to‐target protocols versus usual care 43, 61 provide the basis for the strong recommendation to use a treat‐to‐target strategy with ULT that includes a plan to achieve and maintain an SU target of <6 mg/dl to optimize patient outcomes. If you have not started on your presentation yet, download one of our free PowerPoint poster templates. To facilitate the 2 NMAs, we also considered medications not available in the US to permit comparisons with other available medications in the network analysis. This guideline follows the ACR guideline development process ( https://www.rheum atolo gy.org/Pract ice-Quali ty/Clini cal-Suppo rt/Clini cal-Pract ice-Guide lines) using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology to rate the certainty of evidence and develop recommendations 15-17, with an emphasis on developing actionable guidelines. All require an oral presentation. We conducted systematic literature reviews (including 2 network meta‐analyses [NMAs]) to address each PICO question (for search strategies and study selection process, see Supplementary Appendices 4 and 5, respectively, at http://onlinelibrary.wiley.com/doi/10.1002/acr.24180/abstract). Show it to someone who hasn’t seen it before and observe their reaction. As noted above, data from the RCT of patients with ≤2 previous flares (and no more than 1 gout flare in the preceding year) supported the benefit of ULT for reduction of SU concentration and gout flare risk 27. This updated guideline effort also identifies several areas that inform a research agenda for gout management. If you do not receive an email within 10 minutes, your email address may not be registered, National Radiology QI Guidelines V3. New in 2018, The American College of Rheumatology (ACR) and the Association of Rheumatology Health Professionals (ARHP) invite patients along with patient organizations to submit posters for the new Patient Perspectives Poster Program. Input from the Patient Panel, citing their own ability to simultaneously process information related to flare treatment and ULT initiation together, along with their preference to start on a treatment path sooner to prevent future flares, influenced the final recommendation. Fitzgerald, Dalbeth, Mikuls, Guyatt, Mount, Pillinger, Singh, P. Khanna, Kim, Sehra, Sharma, Toprover, Zeng, Turner, Neogi. Overview of breast manifestations of systemic disease A pictorial review of Breast Lymphoma… Underscoring the importance of optimal flare management, the Patient Panel emphasized its preference for early intervention given the challenges of engaging a provider in timely manner, including an at‐home “medication‐in‐pocket” strategy for patients who are able to identify the early signs of flare onset. Forty‐two recommendations (including 16 strong recommendations) were generated. Informatics or physics topics that address practical applications designed to improve clinical radiology practice or health care data management. Poster Materials should be paper or cardboard and should be laminated. For patients with only infrequent flares, the magnitude of benefit would be substantially smaller than for patients with frequent flares, and there would be no benefit in reduction of tophi when no tophi are present. Under GRADE methodology, recommendations in these guidelines are supported by higher quality studies than the 2012 ACR Guidelines for the Management of Gout. When initiating ULT, concomitant antiinflammatory prophylaxis therapy for a duration of at least 3–6 months was strongly recommended. For patients with infrequent gout flares and no tophi, we would expect a similar benefit in SU reduction. To make the most out of your research experience, and to make it as rewarding as possible, we strongly encourage you to A randomized clinical trial, Initiation of allopurinol at first medical contact for acute attacks of gout: a randomized clinical trial, Significance of the initiation time of urate‐lowering therapy in gout patients: a retrospective research, A pharmacist‐staffed, virtual gout management clinic for achieving target serum uric acid levels: a randomized clinical trial, Adherence and outcomes with urate‐lowering therapy: a site‐randomized trial, Development of preliminary remission criteria for gout using Delphi and 1000Minds consensus exercises, HLA‐B*5801 allele as a genetic marker for severe cutaneous adverse reactions caused by allopurinol, Strong association between HLA‐B*5801 and allopurinol‐induced Stevens‐Johnson syndrome and toxic epidermal necrolysis in a Thai population, Allele frequency net 2015 update: new features for HLA epitopes, KIR and disease and HLA adverse drug reaction associations, The cost‐effectiveness of HLA‐B*5801 screening to guide initial urate‐lowering therapy for gout in the United States, Racial/ethnic variation and risk factors for allopurinol‐associated severe cutaneous adverse reactions: a cohort study, Efficacy and safety of desensitization to allopurinol following cutaneous reactions. The Voting Panel considered the impact of weight loss and specific dietary programs (including the DASH diet 103). Limit your poster presentation to a few main ideas. Furthermore, input from the Patient Panel emphasized that patients are likely to be highly motivated to take ULT due to the symptoms related to the current flare. Continuation of prophylaxis for at least 3–6 months after ULT initiation was recommended because shorter durations were associated with flares upon cessation of prophylaxis 55, 56. 9 In EU-TIRADS, the threshold to indicate active surveillance is <1cm high-risk nodules (EU-TIRADS 5). A complete list of identifiers can be found under the "Safe Harbor method” on the Health and Human Services website. . Strong recommendations reflect decisions supported by moderate or high certainty of evidence where the benefits consistently outweigh the risks, and, with only rare exceptions, an informed patient and his or her provider would be expected to reach the same decision. vs A large observational study (recruitment not selected for CVD) did not show an increased risk of CVD or all‐cause mortality associated with febuxostat initiation compared with allopurinol using methods to address confounding by indication 73. While a specific dose titration schedule is left to provider and patient to individualize based on patient comorbidities and preferences, ULT titration should occur over a reasonable time frame (e.g., weeks to months, not years) to prevent “treatment inertia” 62. Faculty of Radiologists European Working Time Directive position Oct 2009. Based on recent nurse‐ 43 and pharmacist‐led 60, 61 interventions, the Voting Panel supported the benefit of an augmented delivery‐of‐care using patient education and shared decision‐making through implementation of a treat‐to‐target protocol over usual care. An in‐person Patient Panel of 8 male patients with gout, moderated by one of the voting panel members (JAS), reviewed the evidence report (along with a summary and interpretation by the moderator) and provided patient perspectives and preferences. Starting ULT during a flare has conceptual benefits, including the time efficiency offered by initiating therapy during the concurrent flare visit rather than risking the patient not returning for ULT initiation. These guidelines do not directly address the impact of gout or hyperuricemia on other comorbidities, such as cardiovascular disease (CVD), hypertension, urolithiasis, or chronic kidney disease (CKD). Furthermore, treatment options for gout flare are limited in this population, and there may be added benefit of using ULT to prevent progression of renal disease 31. ACR Accreditation 1891 Preston White Dr. Reston, VA 20191. Patient confidentiality must be protected. These guidelines reinforce the strategy of starting with low‐dose ULT and titrating up to achieve the SU target. The first NMA evaluated the impact of starting ULT versus no ULT and the relative impact of the various ULT agents (for details, see Supplementary Appendix 6, available at http://onlinelibrary.wiley.com/doi/10.1002/acr.24180/abstract). We recommend using a treat‐to‐target management strategy to optimize patient outcomes by achieving and maintaining an SU target of <6 mg/dl rather than using a fixed‐dose strategy (Table 3 and Supplementary Figure 2, available at http://onlinelibrary.wiley.com/doi/10.1002/acr.24180/abstract). As we developed these guidelines for use by providers practicing in the US, we considered pharmacologic therapies available in the US, with select exceptions. For colchicine specifically, the FDA‐approved dosing should be followed (1.2 mg immediately followed by 0.6 mg an hour later, with ongoing antiinflammatory therapy until the flare resolves). However, there were no data focused on patients with existing gout. In the FDA‐mandated CARES trial of febuxostat versus allopurinol 72, there was no difference between the 2 arms in the primary composite CVD end point. RANZCR Iodinated Contrast Guidelines Download pdf - 2.3MB This Iodinated Contrast Media Guideline is intended to assist The Royal Australian and New Zealand College of Radiologists®, its staff, Fellows, members and other individuals involved in the administration of iodinated contrast media to patients undergoing medical imaging procedures. Several lesinurad studies demonstrated the benefit of adding a uricosuric medication to XOI treatment 25, 76. A full description of the methods is presented in Supplementary Appendix 1 (available on the Arthritis Care & Research web site at http://onlinelibrary.wiley.com/doi/10.1002/acr.24180/abstract). We thank Janet Joyce for help in developing the literature search strategy and performing the initial literature search, and Janet Waters for performing the update searches. The Core Team prespecified outcomes as critical or important for each PICO question for the systematic literature review. Guidelines and recommendations are intended to promote beneficial or desirable outcomes but cannot guarantee any specific outcome. Patients additionally had contraindication to treatment with allopurinol or history of treatment failure to normalize uric acid despite ≥3 months of treatment with the maximum medically appropriate allopurinol dose (determined by the treating physician). © 2020 American College of Rheumatology. Dr. Mount has received consulting fees from Horizon Pharma (less than $10,000). For patients with moderate‐to‐severe CKD (e.g., stage >3), there is a higher likelihood of gout progression and development of clinical tophi 28-30. Specific characteristics for patients with infrequent flares (e.g., SU concentration >9 mg/dl, CKD, CVD) that might influence the risk‐benefit assessment were considered, but due to insufficient data for these subgroups, the Voting Panel did not find that these conditions warranted stronger ULT recommendations specific to these subgroups. ACR … Worse renal function only had a modest negative impact on urate reduction 44. From the ULT NMA (see Supplementary Appendix 6, available at http://onlinelibrary.wiley.com/doi/10.1002/acr.24180/abstract) and randomized clinical trials (RCTs) of pegloticase 21-23 and lesinurad 24, there was high certainty of evidence regarding the efficacy of ULT in reducing flare frequency 23-26, tophi 21, 23, and SU concentrations 23-26. The ingestion of 1 gm of fructose/kg of body weight increases SU concentration by 1–2 mg/dl within 2 hours of ingestion 100. Supported by the American College of Rheumatology. Management: report of a task force of the EULAR Standing Committee for International Clinical Studies Including Therapeutics (ESCISIT), British Society for Rheumatology and British Health Professionals in Rheumatology guideline for the management of gout, 2016 updated EULAR evidence‐based recommendations for the management of gout, Rising burden of gout in the UK but continuing suboptimal management: a nationwide population study, Comparison of drug adherence rates among patients with seven different medical conditions, The evidence basis for the American College of Rheumatology practice guidelines, The long and winding road to clinical guidelines on the diagnosis and management of gout, GRADE: an emerging consensus on rating quality of evidence and strength of recommendations, The GRADE Working Group clarifies the construct of certainty of evidence, Defining certainty of net benefit: a GRADE concept paper, Outcome measures for gout clinical trials: a summary of progress. The 2012 American College of Rheumatology (ACR) Guidelines for the Management of Gout 5, 6 and other international specialty society guidelines recommend treat‐to‐target strategies with use of urate‐lowering therapy (ULT) 7-10. Likewise, gout patients losing weight through bariatric surgery or diet experienced reduced flare frequency 108, although patients undergoing bariatric surgery may actually have a transient increase in flares risk during the first postoperative month 106. Abstracts can be submitted via the online submission form or alternatively in a Word document submission form and sent to firstname.lastname@example.org. The primary author must be someone who is living with a rheumatic disease. Gout has differential impact on patients by sex, race, or by presence of other comorbidities. As an example, a unit of beer raised SU concentrations by 0.16 mg/dl. A population pharmacokinetic–pharmacodynamics study showed that larger body size and diuretic use indicated the need for higher allopurinol doses to achieve greater urate reduction. The Voting Panel endorsed 42 recommendations overall, including 16 strong recommendations focused on ULT management (indications [n = 3], initiation [n = 6], titration and treat‐to‐target approach [n = 2], approaches following ULT failure [n = 2]), and flare management (n = 3). Unique Viperacr Posters designed and sold by artists. To clarify, as outlined above, there is a strong recommendation to follow a treat‐to‐target management strategy for all patients receiving ULT. Recommendations in this guideline apply to patients with gout, except for a single recommendation regarding the use of ULT in individuals with asymptomatic hyperuricemia, which is defined as an SU concentration of ≥6.8 mg/dl with no prior gout flares or subcutaneous tophi. Likewise, parenteral glucocorticoids were favored over alternative agents when oral dosing is not possible. The Voting Panel's recommendation of colchicine, NSAIDs, or glucocorticoids as preferred first‐line therapies was based on substantial trial data demonstrating efficacy, relative low cost (versus IL‐1 inhibitors and ACTH), and tolerability of these agents in flare management, particularly when administered early after symptom onset. Updates to the guidelines for the management of rheumatoid arthritis (RA) and juvenile idiopathic arthritis (JIA) were previewed at the American College of Rheumatology (ACR… POSTER PDFs Please click on the Poster submissions that you would like to view below: Educational 0014 0026 0029 0030 0035 0040 0042 0048 0050 0058 0075 0102 NHS Breast Screening Programme – Can we safely reduce our clinical recall rate? However, the development of incident gout was low for both ULT and placebo arms (<1% versus 5%) 35, 36. Based on similar efficacy between agents demonstrated in the NMA 79-88, the Voting Panel did not further prioritize between the first‐line agents, noting that treatment selection should be driven by patient factors (e.g., comorbidity, access, past experience) as part of shared decision‐making. Order your ACR poster presentation by November 10th, 2014 to have it on time for the upcoming conference. There is ample evidence that lower SU levels hasten the resolution of tophi 23, 114 and are associated with less frequent gout flares 26, 114, suggesting that lower SU thresholds may be preferable for patients with more burdensome gout. Adrenocorticotropic hormone: an effective “natural” biologic therapy for acute gout?. The Voting Panel reached consensus that data on vitamin C were insufficient to support continued recommendation for its use in patients with gout. Part 2. 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