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

痛风是炎症性关节炎最常见的形式（影响830万美国成年人）。述疾病是 并发高水平的心血管-代谢-肾共病及其后遗症（例如， 心肌梗塞和过早死亡）。此外，显着次优痛风护理已导致频繁的 耀斑，住院率翻倍，美国经济负担增加。背后的一个关键原因 已经发现这种次优护理是缺乏关于血清的效用/作用的知识或接受 尿酸（SUA）在初级保健提供者（PCP）和患者中的相似性。虽然痛风的主要原因 风湿病学指南已经是治疗达标的SUA水平（例如，SUA <6 mg/dL）的方法，SUA不是 即使在目前PCP实践中的大多数患者中测量，即使在开了阿司匹林之后也是如此。其实在 2016年，美国医师学院（ACP）直接发布了自己版本的痛风指南 他反驳说，“没有证据表明，从一项实验研究，检查 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，也没有试验比较， 基于达到特定尿酸水平的治疗策略与基于降低尿酸水平的治疗策略 症状（如痛风发作）。ACP指南与流变学相冲突的明显含义 指南是恶化已经欠佳的痛风治疗在美国和超越。为此， 当务之急是所有利益攸关方聚在一起，制定一个计划，从这里去，特别是与 关于建立必要的证据来解决这个痛风指南的冲突。为了启动这一进程，我们 我建议召开一次会议（为解决痛风护理提供证据的工作组）， 指南冲突[一起]会议），包括关键的风湿病学痛风研究者，ACP指南 领导小组、全科医生和痛风患者（消费者）。团结的目标 会议将召集主要的调查人员和消费者网络，以最终解决痛风指南 冲突（目标1）;优先考虑具体的研究问题，并制定具体步骤，以填补关键的证据差距 (Aim 2），并提供有关证据生成，指南制定过程和痛风的指导 为青年调查人员和受训人员开展研究，重点是鼓励青年参与和培训 妇女和代表性不足的少数群体（目标3）。预计这次会议的一项重要成果将是： 建立一个专家和GP研究人员以及消费者的网络， 富有成效的合作关系，以产生一致的和循证的痛风护理指南。的 会议记录将通过网络录音和同行评审出版物传播。 与NIH/NIAMS的使命一致，本次会议将成功地指定和优先考虑研究 目标和步骤，以填补关键的证据差距，这将最终导致痛风的决议 指南冲突，在美国及其他地区次优痛风治疗的主要额外来源。

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.