ACP releases clinical practice guidelines for acute gout

1. ACP releases clinical practice guidelines for acute gout

Gout is one of the most painful forms of arthritis

Management of gout (free): http://annals.org/aim/article/doi/10.7326/M16-0570

Evidence review (free): http://annals.org/aim/article/doi/10.7326/M16-0461

Diagnosis of gout (free): http://annals.org/aim/article/doi/10.7326/M16-0569

Evidence review (free): http://annals.org/aim/article/doi/10.7326/M16-0462

URLs go live when the embargo lifts

Physicians should use corticosteroids, nonsteroidal anti-inflammatory drugs (NSAIDs), or colchicine to treat patients with acute gout, the American College of Physicians (ACP) recommends in a new evidence-based clinical practice guideline for the management of gout published in Annals of Internal Medicine. ACP recommends that if colchicine is used, it should be at a low dose, as evidence suggests that lower doses of colchicine are as effective as higher doses but are associated with fewer gastrointestinal adverse effects. ACP's guideline for diagnosing gout is published in the same issue.

Gout is one of the most common forms of inflammatory arthritis. It is caused by excess uric acid crystals accumulating in joint fluid, cartilage, bones, tendons, and other sites, which results in joint swelling and pain. ACP recommends against initiating long-term uric acid-lowering therapy in most patients after a first gout attack or in patients with infrequent attacks. While the evidence supports the benefits of using uric acid-lowering therapy for shorter duration to reduce gout flares, the benefits of long term usage for 12 or more months in patients with a single or infrequent gout attacks have not been studied. In cases of recurrent gout, ACP recommends that physicians and patients discuss the benefits, harms, costs, and individual preferences before initiating uric acid-lowering therapy. ACP suggests that comparative effectiveness studies are needed to evaluate the incremental benefits and harms of a treat-to-target strategy over a treat-to-avoid-symptoms strategy.

For diagnosing gout, ACP recommends that physicians use synovial fluid analysis when clinical judgment indicates that diagnostic testing is necessary in patients with possible gout. Misdiagnosis or delayed diagnosis of gout can result in unnecessary surgery, hospitalization, delays in adequate treatment such as antibiotics for septic joints, and unnecessarily prescribing long-term treatment to patients.

The authors of an accompanying editorial http://annals.org/aim/article/doi/10.7326/M16-2401 question the lack of evidence to support a treat-to-target strategy and point out that the physiology of gout is well-known. They suggest that physicians should instead treat the underlying cause of gout -- excess uric acid in the blood -- with urate-lowering therapy. A second editorialist from ACP's Clinical Guideline committee stresses the importance of evidence and outlines the stringent criteria ACP follows to develop its recommendations http://annals.org/aim/article/doi/10.7326/M16-2426.

Note: For an embargoed PDF, please contact Cara Graeff. To speak with someone from ACP, including the guidelines committee editorialist, please contact Steve Majewski at smajewski@acponline.org or 215-351-2415. To speak with the lead author of the first editorial, please contact Gina DiGravio-Wilczewski at ginad@bu.edu or 617-638-8480.

2. Industry-funded studies far less likely to link sugary drinks to obesity

Abstract: http://annals.org/aim/article/doi/10.7326/L16-0534

URLs go live when the embargo lifts

Studies with financial ties to the sugar-sweetened beverage industry are significantly less likely than independent studies to find a link between sugary beverage consumption and metabolic outcomes, such as obesity and diabetes. The findings are published in Annals of Internal Medicine.

The sugar-sweetened beverage industry has opposed recent regulatory initiatives, tax measures, and federal nutritional guidance designed to curb consumption of sugary beverages. Industry argues that science has not proven that sugar-sweetened beverages are a cause of obesity and/or diabetes. Researchers carried out a systematic review to determine whether experimental studies that found no association between sugary drinks and obesity- and diabetes-related outcomes (negative studies) were more likely than positive studies to be financed by industry. Out of 60 studies, 26 articles were negative and 34 found positive associations between sugary drink consumption and obesity or diabetes. One hundred percent of the industry-funded studies were negative, while only one (2.9 percent) of the positive studies had ties to industry. The authors conclude that the sugary beverage industry may be manipulating the scientific process to create controversy and advance their business interests at the expense of the public's health.

Note: For an embargoed PDF, please contact Cara Graeff. To speak with the lead author, Dr. Dean Schillinger, please contact Elizabeth Fernandez at elizabeth.fernandez@ucsf.edu or 415-514-1592.

3. Experts offer 5 core principles to help the next president improve the nation's health

Abstract: http://annals.org/aim/article/doi/10.7326/M16-2471

URLs go live when the embargo lifts

Health policy experts say that advancing health and healthcare in the U.S. is one of the most important actions the next president can take. They offer five core principles that the president could highlight as a way to guide the nation toward better health. These principles focus heavily on eliminating waste in healthcare spending and investing in programs that address the underlying social determinants of health.

Doctors don't vote, but they should

Abstract: http://annals.org/aim/article/doi/10.7326/M16-2470

Healthcare is one of the most important issues facing our nation, yet evidence suggests that doctors are not very engaged in the voting process. Physician voting rates are about 9 percent lower than the general population and 22 percent lower than lawyers. Several factors, such as long working hours and a high level of engagement in their work over outside activities, may contribute to their lagging participation at the polls. The authors provide several tips on how hospitals and medical schools could encourage doctors to vote. They also suggest that doctors identify barriers to voting among their patients as a way to reduce disparities in voter participation and perhaps increase the salience of the right to vote in their work.

Both election commentaries are published in Annals of Internal Medicine.

Note: For an embargoed PDF, please contact Cara Graeff. To speak with the lead author of the core principles commentary, Dr. Stephen Shortell, please contact Linda Anderberg at landerberg@berkeley.edu or 510-643-4707. To speak with the lead author of the voting commentary, Dr. David Grande, please contact Katie DeLach at katie.delach@uphs.upenn.edu or 215-349-5964.

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Also new in this issue:

That Moment
Lucia Briatore, MD, PhD
Annals Graphic Medicine Free content: http://annals.org/aim/article/doi/10.7326/G16-0017

Injuries From an Exploding E-Cigarette: A Case Report
Daniel E. Cason, MD; Desiree E. Morgan, MD; Jason A. Pietryga, MD
Letters and Observations
Abstract: http://annals.org/aim/article/doi/10.7326/L16-0023