What are the core recommendations for gout management in first line and specialist care? Systematic review of clinical practice guidelines.

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Clinical Guidelines
Authored By
Conley B, Bunzli S, Bullen J, O'Brien P, Persaud J, Gunatillake T, Dowsey MM, Choong PF, Nikpour M, Grainger R, Lin I
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Interests
Urology & Nephrology
Immunology Allergy & Inflammation
Internal/Family Medicine
Speciality
Immunology Allergy & Inflammation
Urology & Nephrology
Internal/Family Medicine
Book Detail
volume
7
ISSN
2520-1026
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ISSN
2520-1026
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true
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["Conley B, Bunzli S, Bullen J, O'Brien P, Persaud J, Gunatillake T, Dowsey MM, Choong PF, Nikpour M, Grainger R, Lin I","Publisher: BioMed Central Ltd Country of Publication: England NLM ID: 101738571 Publication Model: Electronic Cited Medium: Internet ISSN: 2520-1026 (Electronic) Linking ISSN: 25201026 NLM ISO Abbreviation: BMC Rheumatol Subsets: PubMed not MEDLINE","Journal Article","2023-06-15","BMC rheumatology [BMC Rheumatol] 2023 Jun 15; Vol. 7 (1), pp. 15. Date of Electronic Publication: 2023 Jun 15.","English","2520-1026","BMC rheumatology","7"]
Description
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.<br />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.<br />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.<br />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.<br />Trial Registration: The protocol for this review was registered with Open Science Framework (DOI https://doi.org/10.17605/OSF.IO/UB3Y7 ).<br /> (© 2023. The Author(s).)
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