Taskforce for the Generation of Evidence to Resolve the Gout Care Guideline Conflict (TOGETHER) Conference

生成证据以解决痛风护理指南冲突的工作组（TOGETHER）会议

• 批准号: 9471664
• 负责人: HYON K CHOI
• 金额: $ 2.2万
• 依托单位: MASSACHUSETTS GENERAL HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-09-20 至 2018-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9471664
• 关键词: Acute; Adult; Affect; American College of Physicians; Cardiovascular system; Caring; Cessation of life; Collaborations; Comorbidity; Conflict (Psychology); Confusion; Deposition; Development; Diagnosis; Disease; Economic Burden; Epidemic; Female; Flare; General Practitioners; Generations; Goals; Gout; Guidelines; Health; Hospitalization; Human; Inflammatory Arthritis; Internet; Kidney; Knowledge; Lead; Leadership; Left; Level of Evidence; Measures; Mentorship; Metabolic; Minority Groups; Mission; Myocardial Infarction; National Institute of Arthritis and Musculoskeletal and Skin Diseases; Outcome; Pain; Patients; Peer Review; Positioning Attribute; Primary Health Care; Process; Provider; Publications; Publishing; Recurrence; Research; Research Personnel; Resolution; Rheumatology; Role; Serum; Societies; Solid; Source; Specialist; Specific qualifier value; Stroke; Symptoms; Training; Underrepresented Minority; United States National Institutes of Health; Urate; Uric Acid; base; comparative effectiveness; compliance behavior; evidence base; evidence based guidelines; experience; experimental study; joint injury; meetings; premature; symposium; trial comparing

Gout is the most common form of inflammatory arthritis (affecting 8.3 million US adults). The disease is complicated by a high level of cardiovascular-metabolic-renal comorbidities and their sequelae (e.g., myocardial infarction and premature death). Furthermore, remarkably suboptimal gout care has led to frequent flares, a doubling of hospitalization rates, and an increased economic burden in the US. A key reason behind this suboptimal care has been found to be a lack of knowledge or acceptance about the utility/role of serum uric acid (SUA) among primary care providers (PCPs) and patients alike. While the mainstay of gout rheumatology guidelines has been a treat-to-target SUA level (e.g., SUA <6 mg/dL) approach, SUA is not even measured in the majority of patients in current PCP practice, even after ULT is prescribed. In fact, in 2016, the American College of Physicians (ACP) published its own version of guidelines for gout directly refuting this approach by stating that “There is no evidence from an experimental study that examined the health outcomes of treating to one serum uric acid level versus another, nor is there a trial comparing a strategy of basing treatment on attaining a specific urate level versus basing treatment on reduction in symptoms (such as gout flares).” The obvious implication of the ACP guidelines conflicting with rheumatology guidelines is the worsening of the already suboptimal gout care in the US and beyond. To that end, it is imperative that all stakeholders get together to formulate a plan for where to go from here, particularly with regard to building the evidence necessary to resolve this gout guideline conflict. To initiate this process, we propose to convene a conference (the Taskforce for the Generation of Evidence to Resolve the Gout Care Guideline Conflict [TOGETHER] Conference) including key rheumatology gout investigators, the ACP guideline leadership group, general practitioners, and gout patients (consumers). The aims of the TOGETHER conference are to assemble key investigators and consumer networks to ultimately resolve the gout guideline conflict (Aim 1); to prioritize specific study questions and develop concrete steps to fill the key evidence gaps (Aim 2), and to provide mentorship about evidence generation, guideline development processes, and gout research for young investigators and trainees, with a focus on encouraging the participation and training of females and underrepresented minority groups (Aim 3). It is anticipated that a key outcome of this meeting will be the creation of a network of specialist and GP researchers as well as consumers that will have a productive and collaborative relationship to generate consistent and evidence-based gout care guidelines. The proceedings of this meeting will be disseminated through a web recording and peer-reviewed publication. Consistent with the mission of the NIH/NIAMS, this meeting will successfully specify and prioritize research goals and steps to fill the critical evidence gap, which will ultimately lead to the resolution of the gout guideline conflict, a major additional source of the suboptimal gout care in the US and beyond.

痛风是最常见的炎症性关节炎（影响 830 万美国成年人）。 并发高水平的心血管代谢肾合并症及其后遗症（例如， 心肌梗死和过早死亡）此外，痛风护理明显欠佳导致频繁发生。 耀斑、住院率翻倍以及美国经济负担增加是背后的一个关键原因。 人们发现这种次优护理是由于对血清的效用/作用缺乏了解或接受 尿酸（SUA）在初级保健提供者（PCP）和患者中都是痛风的中流砥柱。 风湿病学指南一直是治疗目标 SUA 水平（例如，SUA <6 mg/dL）的方法，SUA 不是 事实上，即使在目前的 PCP 实践中，甚至在开出 ULT 后，也对大多数患者进行了测量。 2016年，美国医师学会（ACP）直接发布了自己版本的痛风指南 反驳这种方法，指出“没有任何实验研究证据表明 治疗一种血清尿酸水平与另一种血清尿酸水平的健康结果，也没有一项试验比较 以达到特定尿酸水平为基础的治疗策略与以降低尿酸水平为基础的治疗策略 ACP 指南与风湿病学相冲突的明显含义。 指导方针是美国及其他地区本已不理想的痛风护理的恶化。 所有利益攸关方必须齐心协力，制定下一步的计划，特别是 为了建立解决这一痛风指南冲突所需的证据，我们启动了这一进程。 建议召开一次会议（解决痛风护理问题的证据生成工作组） 指南冲突 [TOGETHER] 会议），包括主要风湿病痛风研究人员、ACP 指南 领导小组、全科医生和痛风患者（消费者） TOGETHER 的目标。 会议将召集主要研究人员和消费者网络，以最终解决痛风指南 冲突（目标 1）；确定具体研究问题的优先顺序并制定具体步骤来填补关键证据空白 （目标 2），并提供有关证据生成、指南制定流程和痛风的指导 针对年轻研究者和受训者的研究，重点是鼓励年轻研究者和受训者的参与和培训 预计本次会议将取得一项关键成果。 建立一个由专家、全科医生研究人员以及消费者组成的网络， 富有成效的协作关系，以制定一致且基于证据的痛风护理指南。 本次会议的记录将通过网络记录和同行评审出版物传播。 与 NIH/NIAMS 的使命相一致，本次会议将成功确定研究的优先顺序 填补关键证据空白的目标和步骤，最终将导致痛风的解决 指南冲突是美国及其他地区痛风护理欠佳的另一个主要根源。