title: Treatment target and followup measures for patients with gout: a systematic literature review.
abstract: OBJECTIVE
  To systematically review the validity of serum uric acid (SUA) as a treatment target for patients with gout, and the clinimetric properties of the potential tools for monitoring these patients.
  
  
  METHODS
  A search was performed in Medline, Embase and the Cochrane Library from inception to October 2011, and the 2010-2011 American College of Rheumatology and European League Against Rheumatism meeting abstracts. Studies evaluating different SUA levels or SUA reduction with the achievement of outcomes, and studies assessing clinimetric properties of instruments used to follow patients with gout were selected. Intervention studies were also included in order to estimate responsiveness. Titles and abstracts of the identified references were screened, and included articles were reviewed in detail and data collected using ad hoc standard forms.
  
  
  RESULTS
  In total, 4575 articles were retrieved, 120 articles reviewed in detail, and 54 articles were included in the systematic literature review. SUA reduction was significantly associated with a reduction in acute attacks (6 studies), tophi regression (2 studies), and crystal clearance (3 studies). SUA 6.0 mg/dl was used as cutoff point in most of studies, but this level was found to be arbitrary. For followup of patients with gout, tophus measurement by caliper and ultrasound, the physical component of the Medical Outcomes Study Short Form-36 Survey, and Health Assessment Questionnaire have shown excellent clinimetric properties for this purpose.
  
  
  CONCLUSIONS
  Reducing SUA is a valid treatment target for patients with gout, but the target level of reduction (cutoff point) is not clear. Some tools were found suitable for following patients with gout.
authors.affiliation: From the Sección de Reumatología, Hospital General Universitario de Alicante, Alicante; Department of Rheumatology, Hospital General Universitario Elda, Spain; Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY, USA; Rheumatology Department, Leiden University Medical Center, Leiden, The Netherlands; and Instituto de Salud Musculoesquelética, Madrid, Spain.M. Andrés, MD, Sección de Reumatología, Hospital General Universitario de Alicante; F. Sivera, MD, Department of Rheumatology, Hospital General Universitario Elda; L. Falzon, PGDipInf, Center for Behavioral Cardiovascular Health, Columbia University Medical Center; D.M. van der Heijde, MD, PhD, Professor of Rheumatology, Rheumatology Department, Leiden University Medical Center; L. Carmona, MD, PhD, Instituto de Salud Musculoesquelética. drmarianoandres@gmail.com.
authors.forename: Mariano
authors.initials: M
authors.lastname: Andrés
authors.affiliation: From the Sección de Reumatología, Hospital General Universitario de Alicante, Alicante; Department of Rheumatology, Hospital General Universitario Elda, Spain; Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY, USA; Rheumatology Department, Leiden University Medical Center, Leiden, The Netherlands; and Instituto de Salud Musculoesquelética, Madrid, Spain.M. Andrés, MD, Sección de Reumatología, Hospital General Universitario de Alicante; F. Sivera, MD, Department of Rheumatology, Hospital General Universitario Elda; L. Falzon, PGDipInf, Center for Behavioral Cardiovascular Health, Columbia University Medical Center; D.M. van der Heijde, MD, PhD, Professor of Rheumatology, Rheumatology Department, Leiden University Medical Center; L. Carmona, MD, PhD, Instituto de Salud Musculoesquelética.
authors.forename: Francisca
authors.initials: F
authors.lastname: Sivera
authors.affiliation: From the Sección de Reumatología, Hospital General Universitario de Alicante, Alicante; Department of Rheumatology, Hospital General Universitario Elda, Spain; Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY, USA; Rheumatology Department, Leiden University Medical Center, Leiden, The Netherlands; and Instituto de Salud Musculoesquelética, Madrid, Spain.M. Andrés, MD, Sección de Reumatología, Hospital General Universitario de Alicante; F. Sivera, MD, Department of Rheumatology, Hospital General Universitario Elda; L. Falzon, PGDipInf, Center for Behavioral Cardiovascular Health, Columbia University Medical Center; D.M. van der Heijde, MD, PhD, Professor of Rheumatology, Rheumatology Department, Leiden University Medical Center; L. Carmona, MD, PhD, Instituto de Salud Musculoesquelética.
authors.forename: Louise
authors.initials: L
authors.lastname: Falzon
authors.affiliation: From the Sección de Reumatología, Hospital General Universitario de Alicante, Alicante; Department of Rheumatology, Hospital General Universitario Elda, Spain; Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY, USA; Rheumatology Department, Leiden University Medical Center, Leiden, The Netherlands; and Instituto de Salud Musculoesquelética, Madrid, Spain.M. Andrés, MD, Sección de Reumatología, Hospital General Universitario de Alicante; F. Sivera, MD, Department of Rheumatology, Hospital General Universitario Elda; L. Falzon, PGDipInf, Center for Behavioral Cardiovascular Health, Columbia University Medical Center; D.M. van der Heijde, MD, PhD, Professor of Rheumatology, Rheumatology Department, Leiden University Medical Center; L. Carmona, MD, PhD, Instituto de Salud Musculoesquelética.
authors.forename: Désirée M
authors.initials: DM
authors.lastname: van der Heijde
authors.affiliation: From the Sección de Reumatología, Hospital General Universitario de Alicante, Alicante; Department of Rheumatology, Hospital General Universitario Elda, Spain; Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY, USA; Rheumatology Department, Leiden University Medical Center, Leiden, The Netherlands; and Instituto de Salud Musculoesquelética, Madrid, Spain.M. Andrés, MD, Sección de Reumatología, Hospital General Universitario de Alicante; F. Sivera, MD, Department of Rheumatology, Hospital General Universitario Elda; L. Falzon, PGDipInf, Center for Behavioral Cardiovascular Health, Columbia University Medical Center; D.M. van der Heijde, MD, PhD, Professor of Rheumatology, Rheumatology Department, Leiden University Medical Center; L. Carmona, MD, PhD, Instituto de Salud Musculoesquelética.
authors.forename: Loreto
authors.initials: L
authors.lastname: Carmona
mesh_terms: D006073:Gout / Q000097:blood* / Q000188:drug therapy*; D006074:Gout Suppressants / Q000627:therapeutic use*; D006801:Humans; D016896:Treatment Outcome; D014527:Uric Acid / Q000097:blood*
chemical_list: D006074:Gout Suppressants; D014527:Uric Acid
keywords: GOUT; IMAGING; PSYCHOMETRIC PROPERTIES; SERUM URIC ACID; VALIDITY