title: Lifestyle interventions for the treatment of gout: a summary of 2 Cochrane systematic reviews.
abstract: OBJECTIVE
  To determine the efficacy and safety of lifestyle interventions for treating gout.
  
  
  METHODS
  Two Cochrane systematic reviews assessed the efficacy and safety of lifestyle interventions for the treatment of acute and chronic gout. We searched MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials up to September 2011, and the 2010-2011 American College of Rheumatology and European League Against Rheumatism conference abstracts. Primary outcomes of interest were joint pain for acute gout, frequency of gout attacks for chronic gout, and withdrawals due to adverse events for both reviews.
  
  
  RESULTS
  One trial met inclusion criteria for each review. An unblinded trial (19 participants), at high risk of bias, found that topical ice added to prednisolone and colchicine for acute gout resulted in significantly greater pain reduction at 1 week [mean difference (MD) -3.33 cm, 95% confidence interval (95% CI) -5.84 to -0.82 on 10 cm visual analog scale]. Adverse events were not described. The second trial (120 participants), at moderate risk of bias, compared enriched skim milk powder (glycomacropeptide and G600 milk fat extract) to non-enriched skim milk and lactose powders for treating chronic gout. There were no between-group differences in gout attack frequency over 3 months [MD -0.21 (95% CI -0.76 to 0.34)] or withdrawals due to adverse events [relative risk 1.27 (95% CI 0.53 to 3.03)].
  
  
  CONCLUSIONS
  While there is observational evidence for an association between lifestyle risk factors and gout development, there are no high quality trials to support or refute the use of lifestyle interventions for treating acute or chronic gout.
authors.affiliation: From the Department of Rheumatology, The Royal Melbourne Hospital, Melbourne, Australia; Rheumatology Department, University Hospital Southampton NHS Foundation Trust, Southampton, UK; Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY, USA; Department of Rheumatology and NIHR Wellcome Trust Clinical Research Facility, University Hospital Southampton NHS Foundation Trust, Southampton, UK; Rheumatology Department, Leiden University Medical Center, Leiden, The Netherlands; Monash Department of Clinical Epidemiology, Cabrini Hospital, Malvern, Victoria, Australia; and Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Malvern, Victoria, Australia.J.H.Y. Moi, BPhysio (Hons), MBBS (Hons), FRACP, Rheumatologist, Department of Rheumatology, The Royal Melbourne Hospital; M.K. Sriranganathan, MBBS, MRCP, Specialist Registrar in Rheumatology and General Internal Medicine, Rheumatology Department, University Hospital Southampton NHS Foundation Trust, L. Falzon, PGDipInf, Center for Behavioral Cardiovascular Health, Columbia University Medical Center; C.J. Edwards, MBBS, MD, FRCP, Department of Rheumatology and NIHR Wellcome Trust Clinical Research Facility, University Hospital Southampton NHS Foundation Trust; D.M. van der Heijde, MD, PhD, Professor of Rheumatology, Rheumatology Department, Leiden University Medical Center; R. Buchbinder, MBBS (Hons), MSc, PhD, FRACP, Director, Monash Department of Clinical Epidemiology, Cabrini Hospital, Malvern; and Professor, Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University.
authors.forename: John H Y
authors.initials: JH
authors.lastname: Moi
authors.affiliation: From the Department of Rheumatology, The Royal Melbourne Hospital, Melbourne, Australia; Rheumatology Department, University Hospital Southampton NHS Foundation Trust, Southampton, UK; Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY, USA; Department of Rheumatology and NIHR Wellcome Trust Clinical Research Facility, University Hospital Southampton NHS Foundation Trust, Southampton, UK; Rheumatology Department, Leiden University Medical Center, Leiden, The Netherlands; Monash Department of Clinical Epidemiology, Cabrini Hospital, Malvern, Victoria, Australia; and Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Malvern, Victoria, Australia.J.H.Y. Moi, BPhysio (Hons), MBBS (Hons), FRACP, Rheumatologist, Department of Rheumatology, The Royal Melbourne Hospital; M.K. Sriranganathan, MBBS, MRCP, Specialist Registrar in Rheumatology and General Internal Medicine, Rheumatology Department, University Hospital Southampton NHS Foundation Trust, L. Falzon, PGDipInf, Center for Behavioral Cardiovascular Health, Columbia University Medical Center; C.J. Edwards, MBBS, MD, FRCP, Department of Rheumatology and NIHR Wellcome Trust Clinical Research Facility, University Hospital Southampton NHS Foundation Trust; D.M. van der Heijde, MD, PhD, Professor of Rheumatology, Rheumatology Department, Leiden University Medical Center; R. Buchbinder, MBBS (Hons), MSc, PhD, FRACP, Director, Monash Department of Clinical Epidemiology, Cabrini Hospital, Malvern; and Professor, Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University.
authors.forename: Melonie K
authors.initials: MK
authors.lastname: Sriranganathan
authors.affiliation: From the Department of Rheumatology, The Royal Melbourne Hospital, Melbourne, Australia; Rheumatology Department, University Hospital Southampton NHS Foundation Trust, Southampton, UK; Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY, USA; Department of Rheumatology and NIHR Wellcome Trust Clinical Research Facility, University Hospital Southampton NHS Foundation Trust, Southampton, UK; Rheumatology Department, Leiden University Medical Center, Leiden, The Netherlands; Monash Department of Clinical Epidemiology, Cabrini Hospital, Malvern, Victoria, Australia; and Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Malvern, Victoria, Australia.J.H.Y. Moi, BPhysio (Hons), MBBS (Hons), FRACP, Rheumatologist, Department of Rheumatology, The Royal Melbourne Hospital; M.K. Sriranganathan, MBBS, MRCP, Specialist Registrar in Rheumatology and General Internal Medicine, Rheumatology Department, University Hospital Southampton NHS Foundation Trust, L. Falzon, PGDipInf, Center for Behavioral Cardiovascular Health, Columbia University Medical Center; C.J. Edwards, MBBS, MD, FRCP, Department of Rheumatology and NIHR Wellcome Trust Clinical Research Facility, University Hospital Southampton NHS Foundation Trust; D.M. van der Heijde, MD, PhD, Professor of Rheumatology, Rheumatology Department, Leiden University Medical Center; R. Buchbinder, MBBS (Hons), MSc, PhD, FRACP, Director, Monash Department of Clinical Epidemiology, Cabrini Hospital, Malvern; and Professor, Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University.
authors.forename: Louise
authors.initials: L
authors.lastname: Falzon
authors.affiliation: From the Department of Rheumatology, The Royal Melbourne Hospital, Melbourne, Australia; Rheumatology Department, University Hospital Southampton NHS Foundation Trust, Southampton, UK; Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY, USA; Department of Rheumatology and NIHR Wellcome Trust Clinical Research Facility, University Hospital Southampton NHS Foundation Trust, Southampton, UK; Rheumatology Department, Leiden University Medical Center, Leiden, The Netherlands; Monash Department of Clinical Epidemiology, Cabrini Hospital, Malvern, Victoria, Australia; and Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Malvern, Victoria, Australia.J.H.Y. Moi, BPhysio (Hons), MBBS (Hons), FRACP, Rheumatologist, Department of Rheumatology, The Royal Melbourne Hospital; M.K. Sriranganathan, MBBS, MRCP, Specialist Registrar in Rheumatology and General Internal Medicine, Rheumatology Department, University Hospital Southampton NHS Foundation Trust, L. Falzon, PGDipInf, Center for Behavioral Cardiovascular Health, Columbia University Medical Center; C.J. Edwards, MBBS, MD, FRCP, Department of Rheumatology and NIHR Wellcome Trust Clinical Research Facility, University Hospital Southampton NHS Foundation Trust; D.M. van der Heijde, MD, PhD, Professor of Rheumatology, Rheumatology Department, Leiden University Medical Center; R. Buchbinder, MBBS (Hons), MSc, PhD, FRACP, Director, Monash Department of Clinical Epidemiology, Cabrini Hospital, Malvern; and Professor, Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University.
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Edwards
authors.affiliation: From the Department of Rheumatology, The Royal Melbourne Hospital, Melbourne, Australia; Rheumatology Department, University Hospital Southampton NHS Foundation Trust, Southampton, UK; Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY, USA; Department of Rheumatology and NIHR Wellcome Trust Clinical Research Facility, University Hospital Southampton NHS Foundation Trust, Southampton, UK; Rheumatology Department, Leiden University Medical Center, Leiden, The Netherlands; Monash Department of Clinical Epidemiology, Cabrini Hospital, Malvern, Victoria, Australia; and Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Malvern, Victoria, Australia.J.H.Y. Moi, BPhysio (Hons), MBBS (Hons), FRACP, Rheumatologist, Department of Rheumatology, The Royal Melbourne Hospital; M.K. Sriranganathan, MBBS, MRCP, Specialist Registrar in Rheumatology and General Internal Medicine, Rheumatology Department, University Hospital Southampton NHS Foundation Trust, L. Falzon, PGDipInf, Center for Behavioral Cardiovascular Health, Columbia University Medical Center; C.J. Edwards, MBBS, MD, FRCP, Department of Rheumatology and NIHR Wellcome Trust Clinical Research Facility, University Hospital Southampton NHS Foundation Trust; D.M. van der Heijde, MD, PhD, Professor of Rheumatology, Rheumatology Department, Leiden University Medical Center; R. Buchbinder, MBBS (Hons), MSc, PhD, FRACP, Director, Monash Department of Clinical Epidemiology, Cabrini Hospital, Malvern; and Professor, Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University.
authors.forename: Désirée M
authors.initials: DM
authors.lastname: van der Heijde
authors.affiliation: From the Department of Rheumatology, The Royal Melbourne Hospital, Melbourne, Australia; Rheumatology Department, University Hospital Southampton NHS Foundation Trust, Southampton, UK; Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY, USA; Department of Rheumatology and NIHR Wellcome Trust Clinical Research Facility, University Hospital Southampton NHS Foundation Trust, Southampton, UK; Rheumatology Department, Leiden University Medical Center, Leiden, The Netherlands; Monash Department of Clinical Epidemiology, Cabrini Hospital, Malvern, Victoria, Australia; and Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Malvern, Victoria, Australia.J.H.Y. Moi, BPhysio (Hons), MBBS (Hons), FRACP, Rheumatologist, Department of Rheumatology, The Royal Melbourne Hospital; M.K. Sriranganathan, MBBS, MRCP, Specialist Registrar in Rheumatology and General Internal Medicine, Rheumatology Department, University Hospital Southampton NHS Foundation Trust, L. Falzon, PGDipInf, Center for Behavioral Cardiovascular Health, Columbia University Medical Center; C.J. Edwards, MBBS, MD, FRCP, Department of Rheumatology and NIHR Wellcome Trust Clinical Research Facility, University Hospital Southampton NHS Foundation Trust; D.M. van der Heijde, MD, PhD, Professor of Rheumatology, Rheumatology Department, Leiden University Medical Center; R. Buchbinder, MBBS (Hons), MSc, PhD, FRACP, Director, Monash Department of Clinical Epidemiology, Cabrini Hospital, Malvern; and Professor, Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University.
authors.forename: Rachelle
authors.initials: R
authors.lastname: Buchbinder
mesh_terms: D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D003131:Combined Modality Therapy; D017679:Cryotherapy; D003611:Dairy Products; D006073:Gout / Q000188:drug therapy / Q000628:therapy*; D006801:Humans; D008019:Life Style; D059408:Pain Management; D011239:Prednisolone / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D000893:Anti-Inflammatory Agents; D011239:Prednisolone
keywords: ATTACKS; DAIRY; DIET; EFFICACY; GOUT; LIFESTYLE