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

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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.