title: Does the initiation of urate-lowering treatment during an acute gout attack prolong the current episode and precipitate recurrent attacks: a systematic literature review.
abstract: The aim of this study was to systematically review the literature on effect of initiating urate-lowering treatment (ULT) during an acute attack of gout on duration of index attack and persistence on ULT. OVID (Medline), EMBASE and AMED were searched to identify randomized controlled trials (RCTs) of ULT initiation during acute gout attack published in English language. Two reviewers appraised the study quality and extracted data independently. Standardized mean difference (SMD) and relative risk (RR) were used to pool continuous and categorical data. Meta-analysis was carried out using STATA version 14. A total of 537 studies were selected. A total of 487 titles and abstracts were reviewed after removing duplicates. Three RCTs were identified. There was evidence from two high-quality studies that early initiation of allopurinol did not increase pain severity at days 10-15 [SMDpooled(95 % CI) 0.18 (-0.58, 0.93)]. Data from three studies suggested that initiation of ULT during an acute attack of gout did not associate with dropouts [RRpooled(95 % CI) 1.16 (0.58, 2.31)]. There is moderate-quality evidence that the initiation of ULT during an acute attack of gout does not increase pain severity and risk of ULT discontinuation. Larger studies are required to confirm these findings so that patients with acute gout can be initiated on ULT with confidence.
authors.affiliation: Department of Medicine, Nottingham University Hospitals NHS Trust, Nottingham, NG7 2UH, UK.
authors.forename: Fatma
authors.initials: F
authors.lastname: Eminaga
authors.affiliation: Department of Medicine, Nottingham University Hospitals NHS Trust, Nottingham, NG7 2UH, UK.
authors.forename: Jonathan
authors.initials: J
authors.lastname: La-Crette
authors.affiliation: Department of Medicine, Nottingham University Hospitals NHS Trust, Nottingham, NG7 2UH, UK.
authors.forename: Adrian
authors.initials: A
authors.lastname: Jones
authors.affiliation: Department of Medicine, Nottingham University Hospitals NHS Trust, Nottingham, NG7 2UH, UK. Abhishek.abhishek@nottingham.ac.uk.|Academic Rheumatology, Clinical Sciences Building, University of Nottingham, Nottingham, NG5 1PB, UK. Abhishek.abhishek@nottingham.ac.uk.
authors.forename: A
authors.initials: A
authors.lastname: Abhishek
mesh_terms: D006073:Gout / Q000188:drug therapy*; D006074:Gout Suppressants / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D012008:Recurrence
chemical_list: D006074:Gout Suppressants
keywords: Acute gout; Systematic review; Urate-lowering treatment