We all recognize the shortcomings of uncontrolled and observational studies, but one might have concluded from the similarity of risk reduction with a treat-to-target approach for acute gout flares found in a review of multiple cohort studies, in addition to the results of long-term follow-up studies of controlled trials, that perhaps the risk reduction was real.
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Explore This IssueFebruary 2017
So the retired general practitioner with tophaceous gout who made such fun of me for my ignorance and general ineptitude anticipated the recent ACP guidelines for the treatment of gout by nearly 30 years. Corticosteroids provided excellent symptomatic relief for his arthritis flares, a treatment recommended by the ACP, although chronic corticosteroids do not reduce the frequency of gouty attacks and have their own side effects. Our general practitioner had clearly presented the risks and benefits of his approach to therapy to himself, and he was more than willing to make the tradeoff of a puffy face, a buffalo hump and some tophi for the avoidance of potential harm from lowering his serum urate levels, whatever that is.
Clearly, this case is an excellent example of a triumph of the “… strategy of basing treatment intensity on minimizing symptoms.”
Bruce N. Cronstein, MD, is a rheumatologist who received his training at NYU School of Medicine. Currently a member of the ACR Board of Directors, Dr. Cronstein directs the NYU-H+H Clinical and Translational Science Institute at NYU School of Medicine.
The ACP guideline can be found here.
Disclosures: Dr. Cronstein has acted as a consultant for Bristol-Myers Squibb and AstraZeneca; he has received grants from AstraZeneca, Celgene and Takeda and has equity in Can-Fite Biopharma. M.S. Dr. Cronstein’s research has been supported by the NIH (ROl AR056672-07, ROl AR068593-02, 1UL1TR001445-02), Arthritis Foundation and Celgene. Dr. Cronstein is the holder of multiple patents.