title: Multinational evidence-based recommendations for the diagnosis and management of gout: integrating systematic literature review and expert opinion of a broad panel of rheumatologists in the 3e initiative.
abstract: We aimed to develop evidence-based multinational recommendations for the diagnosis and management of gout. Using a formal voting process, a panel of 78 international rheumatologists developed 10 key clinical questions pertinent to the diagnosis and management of gout. Each question was investigated with a systematic literature review. Medline, Embase, Cochrane CENTRAL and abstracts from 2010-2011 European League Against Rheumatism and American College of Rheumatology meetings were searched in each review. Relevant studies were independently reviewed by two individuals for data extraction and synthesis and risk of bias assessment. Using this evidence, rheumatologists from 14 countries (Europe, South America and Australasia) developed national recommendations. After rounds of discussion and voting, multinational recommendations were formulated. Each recommendation was graded according to the level of evidence. Agreement and potential impact on clinical practice were assessed. Combining evidence and clinical expertise, 10 recommendations were produced. One recommendation referred to the diagnosis of gout, two referred to cardiovascular and renal comorbidities, six focused on different aspects of the management of gout (including drug treatment and monitoring), and the last recommendation referred to the management of asymptomatic hyperuricaemia. The level of agreement with the recommendations ranged from 8.1 to 9.2 (mean 8.7) on a 1-10 scale, with 10 representing full agreement. Ten recommendations on the diagnosis and management of gout were established. They are evidence-based and supported by a large panel of rheumatologists from 14 countries, enhancing their utility in clinical practice.
authors.affiliation: Department Reumatologia, Hospital General Universitario de Elda, , Elda, Spain.
authors.forename: Francisca
authors.initials: F
authors.lastname: Sivera
authors.forename: Mariano
authors.initials: M
authors.lastname: Andrés
authors.forename: Loreto
authors.initials: L
authors.lastname: Carmona
authors.forename: Alison S R
authors.initials: AS
authors.lastname: Kydd
authors.forename: John
authors.initials: J
authors.lastname: Moi
authors.forename: Rakhi
authors.initials: R
authors.lastname: Seth
authors.forename: Melonie
authors.initials: M
authors.lastname: Sriranganathan
authors.forename: Caroline
authors.initials: C
authors.lastname: van Durme
authors.forename: Irene
authors.initials: I
authors.lastname: van Echteld
authors.forename: Ophir
authors.initials: O
authors.lastname: Vinik
authors.forename: Mihir D
authors.initials: MD
authors.lastname: Wechalekar
authors.forename: Daniel
authors.initials: D
authors.lastname: Aletaha
authors.forename: Claire
authors.initials: C
authors.lastname: Bombardier
authors.forename: Rachelle
authors.initials: R
authors.lastname: Buchbinder
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Edwards
authors.forename: Robert B
authors.initials: RB
authors.lastname: Landewé
authors.forename: Johannes W
authors.initials: JW
authors.lastname: Bijlsma
authors.forename: Jaime C
authors.initials: JC
authors.lastname: Branco
authors.forename: Rubén
authors.initials: R
authors.lastname: Burgos-Vargas
authors.forename: Anca I
authors.initials: AI
authors.lastname: Catrina
authors.forename: Dirk
authors.initials: D
authors.lastname: Elewaut
authors.forename: Antonio J L
authors.initials: AJ
authors.lastname: Ferrari
authors.forename: Patrick
authors.initials: P
authors.lastname: Kiely
authors.forename: Burkhard F
authors.initials: BF
authors.lastname: Leeb
authors.forename: Carlomaurizio
authors.initials: C
authors.lastname: Montecucco
authors.forename: Ulf
authors.initials: U
authors.lastname: Müller-Ladner
authors.forename: Mikkel
authors.initials: M
authors.lastname: Ostergaard
authors.forename: Jane
authors.initials: J
authors.lastname: Zochling
authors.forename: Louise
authors.initials: L
authors.lastname: Falzon
authors.forename: Désirée M
authors.initials: DM
authors.lastname: van der Heijde
mesh_terms: D000208:Acute Disease; D015415:Biomarkers / Q000378:metabolism; D015897:Comorbidity; D016903:Drug Monitoring / Q000379:methods; D019317:Evidence-Based Medicine / Q000379:methods; D006073:Gout / Q000175:diagnosis* / Q000628:therapy*; D006801:Humans; D007391:International Cooperation; D008019:Life Style; D017410:Practice Guidelines as Topic; D014528:Uricosuric Agents / Q000627:therapeutic use
chemical_list: D015415:Biomarkers; D014528:Uricosuric Agents
keywords: Gout; Synovial fluid; Treatment