1. Recommendations for the management of gout: Therapies and Prevention Claire Bombardier, MD, FRCPC Professor of Medicine and Rheumatology Division Director, University of Toronto Senior Scientist, Institute for Work & Health and TGRI, UHN Rheumatologist, Mount Sinai Hospital Canada Research Chair and Co-scientific Director, Canadian Arthritis Network Alison Kydd, MD, PhD, FRCPC Clinical Assistant Professor Division of Rheumatology University of British Columbia Ophir Vinik, MD, MSc, FRCPC Adult Rheumatology Resident University of Toronto

2. 2 3e (evidence, exchange, expertise) topics history 1.2006-2007: Ankylosing Spondylitis 2.2007-2008: Use of Methotrexate in Rheumatoid Arthritis 3.2008-2009: How to investigate and follow-up undifferentiated peripheral inflammatory arthritis? 4.2010- 2011: Pain management by pharmacotherapy in Inflammatory Arthritis 5.2011-2012: Diagnosis and management of Gout

3. 3 AGREE is an integrated research programme currently funded by the Biomedecine and Health Programme (BIOMED-2) of the European Union. M Dougados, et al. EULAR standardised operating procedures for the elaboration, evaluation, dissemination, and implementation of recommendations endorsed by the EULAR standing committees. Ann Rheum Dis 2004;63;1172-6. EULAR and AGREE guidelines eular Methodology Topic & questions Systematic Literature Review National recommendations Multinational recommendations Dissemination Methodology Topic & questions Systematic Literature Review National recommendations Multinational recommendations Dissemination Methodology The methodology used for the development of 3e recommendations is based on the EULAR and AGREE standardised operating procedures for the elaboration, evaluation, dissemination, and implementation of recommendations.

4. 4 3e Initiative general methodology Methodology Topic & questions Systematic Literature Review National recommendations Multinational recommendations Dissemination Methodology Topic & questions Systematic Literature Review National recommendations Multinational recommendations Dissemination Methodology Evidence Systematic Literature Review Expertise Rheumatologists Recommendations Exchange Topic & Questions

5. 5 Relevant questions for the topic Methodology Topic & questions Systematic Literature Review National recommendations Multinational recommendations Dissemination Methodology Topic & questions Systematic Literature Review National recommendations Multinational recommendations Dissemination Topic & questions Opening Multinational meeting Proposals made by the national Steering Committees Final selection of 10 questions Using a modified DELPHI technique, anonymous voting system…

6. 6 Selection of the 10 questions Kickoff meeting – June 24-25, 2011 Proposals made by the national steering committees Vote session (modified Delphi technique) for the choice of the 10 mutinational questions

7. 7 3e initiative 2011-2012

8. 8 Multinational level Chair Désirée van der Heijde Review and transmission of the SLR results Methodology Topic & questions Systematic Literature Review National recommendations Multinational recommendations Dissemination Methodology Topic & questions Systematic Literature Review National recommendations Multinational recommendations Dissemination Systematic Literature Review Mentors Daniel Aletaha Claire Bombardier Rachelle Buchbinder Loreto Carmona Chris Edwards Robert Landewé Multi-national fellows Mariano Andrés Alison Kydd John Moi Rakhi Seth Francisca Sivera Mascaró Melonie Sriranganathan Caroline van Durme Irene van Echteld Ophir Vinic Mihir Wechalekar Librarian Louise Falzon

9. 9 The systematic literature review July 2011 – March 2012

10. 10 10 Questions 5.Alison Kydd What is the efficacy, cost-efficacy and safety for ULT (allopurinol, but also febuxostat, peg-uricase, benzbromarone and probenecid) in the treatment of gout? Which sequence of ULT or combinations of should be recommended? 10.Ophir Vinik Can we prevent gouty arthritis, renal disease and CV events by lowering serum uric acid levels in patients with asymptomatic hyperuricaemia? If yes, what should be the target levels?

11. 11 The teams 12 PIs SWEDEN Anca CATRINA DENMARK Mikkel ØSTERGAARD THE NETHERLANDS Hans BIJLSMA AUSTRIA Burkhard LEEB GERMANY Ulf MULLER-LADNER AUSTRALIA – NEW ZEALAND Jane ZOCHLING BRAZIL Antonio José LOPES FERRARI MEXICO Rubén BURGOS VARGAS UNITED KINGDOM Patrick KIELY BELGIUM - LUXEMBOURG Dirk ELEWAUT PORTUGAL Jaime BRANCO ITALY Carlomaurizio MONTECUCCO

12. 12 National recommendations Methodology Topic & questions Systematic Literature Review National recommendations Multinational recommendations Dissemination Methodology Topic & questions Systematic Literature Review National recommendations Multinational recommendations Dissemination National recommendations

13. 13 Closing meeting Methodology Topic & questions Systematic Literature Review National recommendations Multinational recommendations Dissemination Methodology Topic & questions Systematic Literature Review National recommendations Multinational recommendations Dissemination Multinational recommendations Agreement on one set of multinational recommendations

14. 14 3e Initiative 2011-2012 at a glance FebruarySeptemberJuneMarch-MayJune … Kickoff All participants June 24-25 Bibliographic Meeting Only multinational mentors and fellows September 2-3, Prague SLR Final results Available on blog March 5 Bibliographic Meeting + PIs PIs, Mentors and Fellows February 2-4, Lisbon National meetings March to May Closing Meeting All participants June 22-23, Brussels, Dolce 20112012 Dissemination …

15. 15 Main Paper presenting the recommendations published in ARD Ann Rheum Dis. 2011 Jan;70(1):15-24. Epub 2010 Aug 19. Publications: example for UPIA Supplement of the Journal of Rheumatology entirely dedicated to 3e UPIA with 11 articles Supplement 87 published in March 2011 Methodology Topic & questions Systematic Literature Review National recommendations Multinational recommendations Dissemination Methodology Topic & questions Systematic Literature Review National recommendations Multinational recommendations Dissemination

16. 16 3e Pain Publications Entire supplement of the Journal of Rheumatology dedicated to 3e Pain to be published in early September 8 Cochrane reviews Main Paper published in Rheumatology online March 2012 EULAR 2011: 2 oral communications 5 posters