title: 2016 updated EULAR evidence-based recommendations for the management of gout.
abstract: BACKGROUND
  New drugs and new evidence concerning the use of established treatments have become available since the publication of the first European League Against Rheumatism (EULAR) recommendations for the management of gout, in 2006. This situation has prompted a systematic review and update of the 2006 recommendations.
  
  
  METHODS
  The EULAR task force consisted of 15 rheumatologists, 1 radiologist, 2 general practitioners, 1 research fellow, 2 patients and 3 experts in epidemiology/methodology from 12 European countries. A systematic review of the literature concerning all aspects of gout treatments was performed. Subsequently, recommendations were formulated by use of a Delphi consensus approach.
  
  
  RESULTS
  Three overarching principles and 11 key recommendations were generated. For the treatment of flare, colchicine, non-steroidal anti-inflammatory drugs (NSAIDs), oral or intra-articular steroids or a combination are recommended. In patients with frequent flare and contraindications to colchicine, NSAIDs and corticosteroids, an interleukin-1 blocker should be considered. In addition to education and a non-pharmacological management approach, urate-lowering therapy (ULT) should be considered from the first presentation of the disease, and serum uric acid (SUA) levels should be maintained at<6 mg/dL (360 µmol/L) and <5 mg/dL (300 µmol/L) in those with severe gout. Allopurinol is recommended as first-line ULT and its dosage should be adjusted according to renal function. If the SUA target cannot be achieved with allopurinol, then febuxostat, a uricosuric or combining a xanthine oxidase inhibitor with a uricosuric should be considered. For patients with refractory gout, pegloticase is recommended.
  
  
  CONCLUSIONS
  These recommendations aim to inform physicians and patients about the non-pharmacological and pharmacological treatments for gout and to provide the best strategies to achieve the predefined urate target to cure the disease.
authors.affiliation: AP-HP, hôpital Lariboisière, service de Rhumatologie, F-75010 Paris, France; Inserm, UMR1132, Hôpital Lariboisière, F-75010 Paris, France; Universitè Paris Diderot, Sorbonne Paris Citè, F-75205 Paris, France.
authors.forename: P
authors.initials: P
authors.lastname: Richette
authors.affiliation: Academic Rheumatology, University of Nottingham, Nottingham, UK.
authors.forename: M
authors.initials: M
authors.lastname: Doherty
authors.affiliation: Department of Rheumatology, Hospital General Universitario de Alicante, Alicante, Spain.
authors.forename: E
authors.initials: E
authors.lastname: Pascual
authors.affiliation: Institute of Rheumatology RAMS, Moscow, Russia.
authors.forename: V
authors.initials: V
authors.lastname: Barskova
authors.affiliation: Department of Diagnostic and Interventional Radiology, Lausanne University Hospital, Lausanne, Switzerland.
authors.forename: F
authors.identifier: http://orcid.org/0000-0001-8444-8504
authors.initials: F
authors.lastname: Becce
authors.affiliation: AP-HP, Dèpartement d'Epidèmiologie et Recherche Clinique, Hôpital Bichat, Paris, France: APHP, Centre de Pharmacoèpidèmiologie, Paris, France: Univ Paris Diderot, Paris, France: INSERM UMR 1123 ECEVE, Paris, France.
authors.forename: J
authors.initials: J
authors.lastname: Castañeda-Sanabria
authors.affiliation: Patient from Nottingham, UK, Paris.
authors.forename: M
authors.initials: M
authors.lastname: Coyfish
authors.affiliation: AP-HP, Dèpartement d'Epidèmiologie et Recherche Clinique, Hôpital Bichat, Paris, France: APHP, Centre de Pharmacoèpidèmiologie, Paris, France: Univ Paris Diderot, Paris, France: INSERM UMR 1123 ECEVE, Paris, France.
authors.forename: S
authors.initials: S
authors.lastname: Guillo
authors.affiliation: Department of Rheumatology, VieCuri Medical Centre, Venlo, and Scientific IQ HealthCare, Radboud UMC, Nijmegen, The Netherlands.
authors.forename: T L
authors.initials: TL
authors.lastname: Jansen
authors.affiliation: Department of Primary and Community Care, Radboud University Medical Centre, Nijmegen, Netherlands.
authors.forename: H
authors.initials: H
authors.lastname: Janssens
authors.affiliation: AP-HP, hôpital Lariboisière, service de Rhumatologie, F-75010 Paris, France; Inserm, UMR1132, Hôpital Lariboisière, F-75010 Paris, France; Universitè Paris Diderot, Sorbonne Paris Citè, F-75205 Paris, France.
authors.forename: F
authors.initials: F
authors.lastname: Lioté
authors.affiliation: Arthritis Research UK Primary Care Centre University of Keele, Keele, UK.
authors.forename: C
authors.initials: C
authors.lastname: Mallen
authors.affiliation: Osteoarticular Research Group, University of Edinburgh, Edinburgh, UK.
authors.forename: G
authors.initials: G
authors.lastname: Nuki
authors.affiliation: Seccion de Rheumatologia, Hospital de Cruces, Baracaldo, Spain.
authors.forename: F
authors.initials: F
authors.lastname: Perez-Ruiz
authors.affiliation: Rheumatology Unit, Clínica Coração de Jesus, Lisbon, Portugal.
authors.forename: J
authors.initials: J
authors.lastname: Pimentao
authors.affiliation: Rheumatology Unit, University of Padova, Padova, Italy.
authors.forename: L
authors.initials: L
authors.lastname: Punzi
authors.affiliation: Patient from Nottingham, UK, Paris.
authors.forename: T
authors.initials: T
authors.lastname: Pywell
authors.affiliation: Service de Rhumatologie, CHUV and Universitè de Lausanne, Lausanne, Switzerland.
authors.forename: A
authors.initials: A
authors.lastname: So
authors.affiliation: Department of Rheumatology, University Clinic at the Technical University Dresden, Germany.
authors.forename: A K
authors.initials: AK
authors.lastname: Tausche
authors.affiliation: Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway.
authors.forename: T
authors.initials: T
authors.lastname: Uhlig
authors.affiliation: Institute of Rheumatology, Prague, and Department of Rheumatology, First Faculty of Medicine, Charles University in Prague, Czech Republic.
authors.forename: J
authors.initials: J
authors.lastname: Zavada
authors.affiliation: Academic Rheumatology, University of Nottingham, Nottingham, UK.
authors.forename: W
authors.initials: W
authors.lastname: Zhang
authors.affiliation: AP-HP, Dèpartement d'Epidèmiologie et Recherche Clinique, Hôpital Bichat, Paris, France: APHP, Centre de Pharmacoèpidèmiologie, Paris, France: Univ Paris Diderot, Paris, France: INSERM UMR 1123 ECEVE, Paris, France.
authors.forename: F
authors.initials: F
authors.lastname: Tubach
authors.affiliation: AP-HP, hôpital Lariboisière, service de Rhumatologie, F-75010 Paris, France; Inserm, UMR1132, Hôpital Lariboisière, F-75010 Paris, France; Universitè Paris Diderot, Sorbonne Paris Citè, F-75205 Paris, France.
authors.forename: T
authors.initials: T
authors.lastname: Bardin
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D003697:Delphi Technique; D037001:Directive Counseling; D019317:Evidence-Based Medicine; D006073:Gout / Q000097:blood / Q000188:drug therapy* / Q000628:therapy; D006074:Gout Suppressants / Q000627:therapeutic use*; D006801:Humans; D007375:Interleukin-1 / Q000037:antagonists & inhibitors; D008019:Life Style; D010353:Patient Education as Topic; D000067251:Symptom Flare Up; D014527:Uric Acid / Q000097:blood
chemical_list: D000305:Adrenal Cortex Hormones; D000894:Anti-Inflammatory Agents, Non-Steroidal; D006074:Gout Suppressants; D007375:Interleukin-1; D014527:Uric Acid
keywords: Gout; Multidisciplinary team-care; Treatment