The Long and Winding Road to Clinical Guidelines on the Diagnosis and Management of Gout
Authors: Robert M. McLean
Journal: Annals of Internal Medicine (2016)

Editorials3 January 2017The Long and Winding Road to Clinical Guidelines on the Diagnosis and Management of GoutRobert M. McLean, MDRobert M. McLean, MDFrom Northeast Medical Group; Yale New Haven Health System; New Haven, Connecticut.Author, Article, and Disclosure Informationhttps://doi.org/10.7326/M16-2426 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail The new clinical practice guidelines (CPGs) on the diagnosis and management of gout from the American College of Physicians (ACP) Clinical Guidelines Committee (1, 2) have some distinct differences from the 2012 American College of Rheumatology (ACR) guidelines (3). Consequently, the ACP recommendations likely will ignite controversy. How can guideline committees from 2 highly respected professional organizations come up with different recommendations?Let's start by considering the definition of guidelines. In 1990, the Institute of Medicine released "Clinical Practice Guidelines: Directions for a New Program," in which it defined CPGs as "systematically developed statements to assist practitioner and patient decisions ...References1. Qaseem A, McLean RM, Starkey M, Forciea MA; Clinical Guidelines Committee of the American College of Physicians. Diagnosis of acute gout: a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2017;166:52-7. doi:10.7326/M16-0569 LinkGoogle Scholar2. Qaseem A, Harris RP, Forciea MA; Clinical Guidelines Committee of the American College of Physicians. Management of acute and recurrent gout: a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2017;166:58-68. doi:10.7326/M16-0570 LinkGoogle Scholar3. Khanna D, Fitzgerald JD, Khanna PP, Bae S, Singh MK, Neogi T, et al; American College of Rheumatology. 2012 American College of Rheumatology guidelines for management of gout. Part 1: systematic nonpharmacologic and pharmacologic therapeutic approaches to hyperuricemia. Arthritis Care Res (Hoboken). 2012;64:1431-46. [PMID: 23024028] doi:10.1002/acr.21772 CrossrefMedlineGoogle Scholar4. Field MJ, Lohr KN, eds. Committee to Advise the Public Health Service on Clinical Practice Guidelines; Institute of Medicine. Clinical Practice Guidelines: Directions for a New Program. Washington, DC: National Academies Pr; 1990. Google Scholar5. Graham R, Mancher M, Wolman DM, Greenfield S, Steinberg E, eds. Committee on Standards for Developing Trustworthy Clinical Practice Guidelines. Board on Health Care Services; Institute of Medicine. Clinical Practice Guidelines We Can Trust. Washington, DC: National Academies Pr; 2011. Google Scholar6. Eden J, Levit L, Berg A, Morton S, eds. Committee on Standards for Systematic Reviews of Comparative Effectiveness Research. Board on Health Care Services; Institute of Medicine. Finding What Works in Health Care: Standards for Systematic Reviews. Washington, DC: National Academies Pr; 2011. Google Scholar7. Moyer VA, LaFevre M, Calogne N. Is it time for the USPSTF to inform—but not determine—coverage? Ann Intern Med. 2016;165:876-7. doi:10.7326/M16-2304 LinkGoogle Scholar8. Newberry SJ, FitzGerald JD, Motala A, Booth M, Maglione MA, Han D, et al. Diagnosis of gout: a systematic review in support of an American College of Physicians clinical practice guideline. Ann Intern Med. 2017;166:27-36. doi:10.7326/M16-0462 LinkGoogle Scholar9. Shekelle PG, Newberry SJ, FitzGerald JD, Motala A, O'Hanlon CE, Tariq A, et al. Management of gout: a systematic review in support of an American College of Physicians clinical practice guideline. Ann Intern Med. 2017;166:37-51. doi:10.7326/M16-0461 LinkGoogle Scholar10. Kiltz U, Smolen J, Bardin T, Solal AC, Dalbeth N, Doherty M, et al. Treat-to-target (T2T) recommendations for gout. Ann Rheum Dis. 2016. doi:10.1136/annrheumdis-2016-209467 CrossrefGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From Northeast Medical Group; Yale New Haven Health System; New Haven, Connecticut.Disclosures: Dr. McLean reports personal fees from Takeda Pharmaceuticals speakers' bureau before 2015 and outside the submitted work. He is a member of the ACP CGC and the American College of Rheumatology Quality of Care Committee. Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M16-2426.Corresponding Author: Robert M. McLean, MD, Northeast Medical Group, 46 Prince Street, New Haven, CT 06519; e-mail, robert.[email protected]org.Author Contributions: Drafting of the article: R.M. McLean.Final approval of the article: R.M. McLean.Administrative, technical, or logistic support: R.M. McLean.Current Author Addresses: Robert M. McLean, MD, Northeast Medical Group, 46 Prince Street, New Haven, CT 06519.This article was published at www.annals.org on 1 November 2016. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoTo Treat or Not to Treat (to Target) in Gout Tuhina Neogi and Ted R. Mikuls Diagnosis of Gout: A Systematic Review in Support of an American College of Physicians Clinical Practice Guideline Sydne J. Newberry , John D. FitzGerald , Aneesa Motala , Marika Booth , Margaret A. Maglione , Dan Han , Abdul Tariq , Claire E. O'Hanlon , Roberta Shanman , Whitney Dudley , and Paul G. Shekelle Diagnosis of Acute Gout: A Clinical Practice Guideline From the American College of Physicians Amir Qaseem , Robert M. McLean , Melissa Starkey , Mary Ann Forciea , and Management of Gout: A Systematic Review in Support of an American College of Physicians Clinical Practice Guideline Paul G. Shekelle , Sydne J. Newberry , John D. FitzGerald , Aneesa Motala , Claire E. O'Hanlon , Abdul Tariq , Adeyemi Okunogbe , Dan Han , and Roberta Shanman Management of Acute and Recurrent Gout: A Clinical Practice Guideline From the American College of Physicians Amir Qaseem , Russell P. Harris , Mary Ann Forciea , and Annals On Call - The Gout Wars: When Guidelines Collide Robert M. Centor and Robert M. 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