Limitations of the Current Standards of Care for Treating Gout and Crystal Deposition in the Primary Care Setting: A Review.
نویسنده
چکیده
PURPOSE This article outlines several important issues regarding the management of patients with gout. The topics discussed include best practices for gout based on the most current guidelines, opportunities for improving gout management, and current and emerging therapies for gout. METHODS [PubMed and Google Scholar databases] were search for all articles and trials published before 2016, using the key terms [hyperuricemia, gout, tophi, joint erosion, joint damage, treatment guidelines, American College of Rheumatology (ACR), European League Against Rheumatism (EULAR), flare, comorbidity, epidemiology, adherence, serum uric acid (sUA), monosodium urate (MSU), <6 mg/dL, MSU crystal formation, as well as individual drug names and classes of treatments of interest (allopurinol, febuxostat, colchicine, non-steroidal anti-inflammatories (NSAIDs)]. Studies were selected that presented data on gout treatment, including drugs under development, and on the management of gout from both the physician and patient perspectives. The reference lists of identified articles were searched manually for additional publications. FINDINGS Gout, a progressive debilitating form of inflammatory arthritis, is caused by factors that elevate serum uric acid (sUA) levels, leading to hyperuricemia. Continued elevated sUA can result in monosodium urate crystal deposition in joints and soft tissues, causing acute and chronic inflammation. Crystal deposition can lead to chronic gout, with an increased number of flares, tophi development, and structural joint damage. The aims of gout treatment are to reduce the sUA level to <6 mg/dL, to inhibit the formation of new crystals, and to promote the dissolution of existing crystals. Gout is often poorly managed for several reasons, including a lack of adherence to treatment guidelines by health care providers, patients' poor adherence to therapy, and differences between a provider's and patient's perspectives regarding treatment. IMPLICATIONS Patients need to be educated about their diagnosis and management of the disease, such as the importance of compliance with long-term treatment. Gout treatment may also confounded by contraindications to current standards of therapy and the limitations of current treatment paradigms. Recently approved medications, as well as drugs under development, may provide new ways for reaching the sUA target and also "curing" the disease.
منابع مشابه
Primary Health Care Quality Improvement Patterns: A Systematic Review Study
Background and Aim: Along with the expansion of health systems, the importance of primary health care as the basis of an efficient health system is more evident and the quality of the provided services at this level becomes more important. In this way, the present study attempts to collect patterns used to improve the quality of primary health care. Materials and Methods: The present study is ...
متن کاملNewborn's primary care standards do graduate midwifery
Introduction: First minutes of a baby's life are very important stage of life is filled with danger, this study aimed to assess the infant's primary care standards do graduate midwifes. Methods: Present research is a cross-sectional study. Statistical society of this research is a group of recent graduated midwifes including 50 persons, have graduated in the recent three years and are providin...
متن کاملModels of clinical reasoning with a focus on general practice: a critical review
Introduction: Diagnosis lies at the heart of general practice.Every day general practitioners (GPs) visit patients with awide variety of complaints and concerns, with often minor butsometimes serious symptoms. General practice has many featureswhich differentiate it from specialty care setting, but during thelast four decades little attention was paid to clinical reasoningin general practice. T...
متن کاملA Review the Role of Midwife-led Care Model in Managing the Costs of Healthy Reproductive Services
Objective: For improving the quality of reproductive health services and providing appropriate health care to mothers to reduce their mortality and morbidity, it requires to apply the effective cost models used in the world. In this regard, the aim of the current study is to critically review the related literature on cost management of healthy reproductive services with the continuous midwifer...
متن کاملRequired Structures for Family Physician Program for Achieving Service Quality Dimensions in Primary Health Care: a Systematic Review
Background: The Structure of Health System affects quality of care in family physician program. This study aimed to explore the required structures of Family Physician Program for achieving service quality dimensions in Primary Health care through analyzing country experiences. These structures will be useful in achievement of quality health care in family physician system. Methods: In this sy...
متن کاملذخیره در منابع من
با ذخیره ی این منبع در منابع من، دسترسی به آن را برای استفاده های بعدی آسان تر کنید
برای دانلود متن کامل این مقاله و بیش از 32 میلیون مقاله دیگر ابتدا ثبت نام کنید
ثبت ناماگر عضو سایت هستید لطفا وارد حساب کاربری خود شوید
ورودعنوان ژورنال:
- Clinical therapeutics
دوره 39 2 شماره
صفحات -
تاریخ انتشار 2017