title: Treat-to-target (T2T) recommendations for gout.
abstract: OBJECTIVE
  The treat-to-target (T2T) concept has been applied successfully in several inflammatory rheumatic diseases. Gout is a chronic disease with a high burden of pain and inflammation. Because the pathogenesis of gout is strongly related to serum urate levels, gout may be an ideal disease in which to apply a T2T approach. Our aim was to develop international T2T recommendations for patients with gout.
  
  
  METHODS
  A committee of experts with experience in gout agreed upon potential targets and outcomes, which was the basis for the systematic literature search. Eleven rheumatologists, one cardiologist, one nephrologist, one general practitioner and one patient met in October 2015 to develop T2T recommendations based on the available scientific evidence. Levels of evidence, strength of recommendations and levels of agreement were derived.
  
  
  RESULTS
  Although no randomised trial was identified in which a comparison with standard treatment or an evaluation of a T2T approach had been performed in patients with gout, indirect evidence was provided to focus on targets such as normalisation of serum urate levels. The expert group developed four overarching principles and nine T2T recommendations. They considered dissolution of crystals and prevention of flares to be fundamental; patient education, ensuring adherence to medications and monitoring of serum urate levels were also considered to be of major importance.
  
  
  CONCLUSIONS
  This is the first application of the T2T approach developed for gout. Since no publication reports a trial comparing treatment strategies for gout, highly credible overarching principles and level D expert recommendations were created and agreed upon.
authors.affiliation: Rheumazentrum Ruhrgebiet, and Ruhr University Bochum, Herne, Germany.
authors.forename: U
authors.initials: U
authors.lastname: Kiltz
authors.affiliation: Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, Vienna, Austria.
authors.forename: J
authors.identifier: http://orcid.org/0000-0002-8899-9087
authors.initials: J
authors.lastname: Smolen
authors.affiliation: Assisitance Publique Hôpitaux de Paris Rheumatology Department, Lariboisière Hospital, University Paris Diderot, Sorbonne Paris-Cité and INSERM, UMR 1132, Paris, France.
authors.forename: T
authors.initials: T
authors.lastname: Bardin
authors.affiliation: Research Medical Unit INSERM, Université Paris VII-Denis Diderot Assistance Publique-Hôpitaux de Paris, Service de Cardiologie, Hôpital Lariboisière, Paris, France.
authors.forename: A
authors.initials: A
authors.lastname: Cohen Solal
authors.affiliation: University of Auckland and Auckland District Health Board, Auckland, New Zealand.
authors.forename: N
authors.initials: N
authors.lastname: Dalbeth
authors.affiliation: University of Nottingham, Nottingham, UK.
authors.forename: M
authors.initials: M
authors.lastname: Doherty
authors.affiliation: Medical Faculty, Institute of General Practice and Family Medicine, University Bonn, Bonn, Germany.
authors.forename: B
authors.initials: B
authors.lastname: Engel
authors.affiliation: Rheumazentrum Ruhrgebiet, and Ruhr University Bochum, Herne, Germany.
authors.forename: C
authors.initials: C
authors.lastname: Flader
authors.affiliation: UMass Memorial Medical Center and University of Massachusetts Medical School, Worcester, Massachusetts, USA.
authors.forename: J
authors.identifier: http://orcid.org/0000-0002-8970-4260
authors.initials: J
authors.lastname: Kay
authors.affiliation: Carnegie Mellon University, Pittsburgh, Pennsylvania, USA.
authors.forename: M
authors.initials: M
authors.lastname: Matsuoka
authors.affiliation: Rheumatology Division, Hospital de Cruces, Baracaldo, Vizcaya, Spain.
authors.forename: F
authors.initials: F
authors.lastname: Perez-Ruiz
authors.affiliation: Discipline of Rheumatology, Rio de Janeiro State University, Rio de Janeiro, Brazil.
authors.forename: G
authors.initials: G
authors.lastname: da Rocha Castelar-Pinheiro
authors.affiliation: University of Alabama at Birmingham, Birmingham, Alabama, USA.
authors.forename: K
authors.initials: K
authors.lastname: Saag
authors.affiliation: Service de Rhumatologie, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland.
authors.forename: A
authors.initials: A
authors.lastname: So
authors.affiliation: Servicio de Reumatología, Hospital General de México, México City, México.
authors.forename: J
authors.initials: J
authors.lastname: Vazquez Mellado
authors.affiliation: Division of Rheumatology, Cedars-Sinai Medical Center, David Geffen School of Medicine at UCLA, Los Angeles, USA.
authors.forename: M
authors.initials: M
authors.lastname: Weisman
authors.affiliation: Medical Department I, Marien Hospital Herne, Ruhr-University of Bochum, Herne, Germany.
authors.forename: T H
authors.initials: TH
authors.lastname: Westhoff
authors.affiliation: Tokyo Women's Medical University, Tokyo, Japan.
authors.forename: H
authors.initials: H
authors.lastname: Yamanaka
authors.affiliation: Rheumazentrum Ruhrgebiet, and Ruhr University Bochum, Herne, Germany.
authors.forename: J
authors.initials: J
authors.lastname: Braun
mesh_terms: D002908:Chronic Disease; D006073:Gout / Q000097:blood* / Q000188:drug therapy*; D017408:Guidelines as Topic; D006801:Humans; D007668:Kidney / Q000503:physiopathology; D008019:Life Style; D055118:Medication Adherence; D010347:Patient Care Planning; D010353:Patient Education as Topic; D010358:Patient Participation; D012196:Review Literature as Topic; D014527:Uric Acid / Q000097:blood*
chemical_list: D014527:Uric Acid
keywords: Gout; Qualitative research; Treatment