Ult

• About
• Methodology
• Potential Problems
• References

About

Ult is a decision aid tool that determines if a patient has an indication for urate-lowering therapy (ULT) and, if so, whether it is a strong or a conditional indication. It does not provide information about which urate-lowering therapy to use. For that, create a UltAid.

Methodology

The information needed to determine whether ULT is appropriate includes:

• Number of Flares: How many flares has the patient had?
• Frequency of Flares: How frequently does he or she get gout flares? Specifically, how many per flares per year?
• Medical History: Does the patient have any of the following:
• Chronic kidney disease (CKD)
• Urate kidney stones
• Hyperuricemia (elevated blood uric acid)
• Gouty erosions
• Gouty tophi

The ULT will use this information to determine whether there is an indication for urate-lowering therapy or not. The American College of Rheumatology Guidelines for the Management of Gout¹ are used to determine the strength of the indication.

Outcomes

ULT outcomes are based in the GRADE methodology ^{2, 3, 4}.

Strong Indication

The panel of individuals writing the guidelines is confident that the desirable effects of adherence to a recommendation outweigh the undesirable effects.

• For patients — this means most people in your situation would want the recommended course of action and only a small proportion would not; request discussion if the intervention is not offered.
• For clinicians — most patients should receive the recommended course of action.

Conditional Indication

The panel writing the guidelines concludes that the desirable effects of adherence to a recommendation probably outweigh the undesirable effects, but is not confident.

• For patients — most people in your situation would want the recommended course of action, but many would not.
• For clinicians — you should recognize that different choices will be appropriate for different patients and that you must help each patient to arrive at a management decision consistent with his or her values and preferences.

Not Indicated

This means that the treatment is not appropriate for the patient.

References

1. FitzGerald JD, Dalbeth N, Mikuls T, Brignardello-Petersen R, Guyatt G, Abeles AM, Gelber AC, Harrold LR, Khanna D, King C, Levy G, Libbey C, Mount D, Pillinger MH, Rosenthal A, Singh JA, Sims JE, Smith BJ, Wenger NS, Bae SS, Danve A, Khanna PP, Kim SC, Lenert A, Poon S, Qasim A, Sehra ST, Sharma TSK, Toprover M, Turgunbaev M, Zeng L, Zhang MA, Turner AS, Neogi T. 2020 American College of Rheumatology Guideline for the Management of Gout. Arthritis Care Res (Hoboken). 2020 Jun;72(6):744-760. doi: 10.1002/acr.24180. Epub 2020 May 11. Erratum in: Arthritis Care Res (Hoboken). 2020 Aug;72(8):1187. Erratum in: Arthritis Care Res (Hoboken). 2021 Mar;73(3):458. PMID: 32391934.

2. Guyatt GH, Oxman AD, Kunz R, Vist GE, Falck-Ytter Y, Schunemann HJ. What is "quality of evidence" and why is it important to clinicians? BMJ (Clinical research ed). 2008;336(7651):995-8. PMID: 18456631.

3. Guyatt GH, Oxman AD, Vist GE, Kunz R, Falck-Ytter Y, Alonso-Coello P, et al. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ (Clinical research ed). 2008;336(7650):924-6. PMID: 18436948.

4. Guyatt G, Oxman AD, Akl EA, Kunz R, Vist G, Brozek J, et al.GRADE guidelines: 1. Introduction-GRADE evidence profiles and summary of findings tables. Journal of clinical epidemiology. 2011;64(4):383-94. PMID: 21195583.