What are the core recommendations for gout management in first line and specialist care? Systematic review of clinical practice guidelines
BMC Rheumatology · 2023 · Europe
Source and licence
- Authors
- Brooke Conley, Samantha Bunzli, Jonathan Bullen et al.
- Title
- What are the core recommendations for gout management in first line and specialist care? Systematic review of clinical practice guidelines
- Journal
- BMC Rheumatology, 2023
- Licence
- CC BY 4.0
- Changes
- Verbatim excerpts; formatting adapted
Full text retrieved 2026-10-27 from Europe PMC · PMC10268528
Licence statement of the original publication
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This page reproduces excerpts of the original publication; the original is authoritative. It has not been reviewed by a physician, does not state a recommendation of Medelix and does not replace medical advice. The guideline may have been updated since.
This is a review of another guideline (Gout guidelines (EULAR 2016, BSR 2017, ACR 2020), EULAR / BSR / ACR 2023). We do not reproduce that guideline's recommendations here – they belong to the original guideline.
Open the original publication →Full text on Europe PMC
Abstract
Background: Gout is the most common inflammatory arthritis, increasing in prevalence and burden. Of the rheumatic diseases, gout is the best-understood and potentially most manageable condition. However, it frequently remains untreated or poorly managed. The purpose of this systematic review is to identify Clinical Practice Guidelines (CPG) regarding gout management, evaluate their quality, and to provide a synthesis of consistent recommendations in the high-quality CPGs.
Methods: Gout management CPGs were eligible for inclusion if they were (1) written in English and published between January 2015-February 2022; focused on adults aged ≥ 18 years of age; and met the criteria of a CPG as defined by the Institute of Medicine; and (2) were rated as high quality on the Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument. Gout CPGs were excluded if they required additional payment to access; only addressed recommendations for the system/organisation of care and did not include interventional management recommendations; and/or included other arthritic conditions. OvidSP MEDLINE, Cochrane, CINAHL, Embase and Physiotherapy Evidence Database (PEDro) and four online guideline repositories were searched.
Results: Six CPGs were appraised as high quality and included in the synthesis. Clinical practice guidelines consistently recommended education, commencement of non-steroidal anti-inflammatories, colchicine or corticosteroids (unless contraindicated), and assessment of cardiovascular risk factors, renal function, and co-morbid conditions for acute gout management. Consistent recommendations for chronic gout management were urate lowering therapy (ULT) and continued prophylaxis recommended based on individual patient characteristics. Clinical practice guideline recommendations were inconsistent on when to initiate ULT and length of ULT, vitamin C intake, and use of pegloticase, fenofibrate and losartan.
Conclusion: Management of acute gout was consistent across CPGs. Management of chronic gout was mostly consistent although there were inconsistent recommendations regarding ULT and other pharmacological therapies. This synthesis provides clear guidance that can assist health professionals to provide standardised, evidence-based gout care.
Trial registration: The protocol for this review was registered with Open Science Framework (DOI 10.17605/OSF.IO/UB3Y7).
Supplementary Information: The online version contains supplementary material available at 10.1186/s41927-023-00335-w.
Contents of the original publication
The section headings of the original.
- Background
- Methods
- Search strategy and eligibility criteria
- Protocol changes
- Study selection
- Data appraisal: Quality assessment of guidelines
- Inter-rater agreement
- Data extraction
- Narrative summary
- Results
- Data extraction
- Quality of CPGs
- Consensus recommendations (Fig. 2; Appendix 7)
- Treatment of gout flare
- Recommendations with ‘Should do’ consensus
- Recommendations with ‘Could do’ consensus
- Recommendations with ‘Do not do’ consensus
- Chronic gout management
- Recommendations with ‘Should do’ consensus
- Recommendations with ‘Could do’ consensus
- Recommendations with ‘Do not do’ consensus
- Recommendations with no consensus
- Discussion
- Further areas of research
- Strengths and Limitations
- Conclusions
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