Evidence map›Paper›PMID 37316871›Full record

ArticleBMC rheumatology2023

What are the core recommendations for gout management in first line and specialist care? Systematic review of clinical practice guidelines.

Brooke Conley, Samantha Bunzli, Jonathan Bullen, Penny O'Brien, Jennifer Persaud, Tilini Gunatillake, Michelle M Dowsey, Peter F Choong, Mandana Nikpour, Rebecca Grainger and 1 more

Open access · goldAbstract read
In one paragraph

Article in BMC rheumatology, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed
2.2field-weighted citation impact, top 12% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed, 11 citations in OpenAlex.

  1. Article
  2. Review
  3. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

11 authors at 6 institutions in 2 countries.

Brooke ConleyDepartment of Surgery, The University of Melbourne, St Vincent's Hospital Melbourne, Level 2, Clinical Sciences Building, 29 Regent St, Fitzroy, VIC, 3065, Australia. bccon@student.unimelb.edu.au.
Samantha BunzliDepartment of Physiotherapy, The University of Melbourne, Melbourne, VIC, Australia.
Jonathan BullenEnAble Institute, Curtin University, Perth, WA, Australia.
Penny O'BrienDepartment of Surgery, The University of Melbourne, St Vincent's Hospital Melbourne, Level 2, Clinical Sciences Building, 29 Regent St, Fitzroy, VIC, 3065, Australia.
Jennifer PersaudArthritis and Osteoporosis Western Australia, Perth, WA, Australia.
Tilini GunatillakeDepartment of Surgery, The University of Melbourne, St Vincent's Hospital Melbourne, Level 2, Clinical Sciences Building, 29 Regent St, Fitzroy, VIC, 3065, Australia.
Michelle M DowseyDepartment of Surgery, The University of Melbourne, St Vincent's Hospital Melbourne, Level 2, Clinical Sciences Building, 29 Regent St, Fitzroy, VIC, 3065, Australia.
Peter F ChoongDepartment of Surgery, The University of Melbourne, St Vincent's Hospital Melbourne, Level 2, Clinical Sciences Building, 29 Regent St, Fitzroy, VIC, 3065, Australia.
Mandana NikpourDepartments of Medicine and Rheumatology, The University of Melbourne at St. Vincent's Hospital, Melbourne, VIC, Australia.
Rebecca GraingerDepartment of Medicine, University of Otago Wellington, Wellington, New Zealand.
Ivan LinThe University of Western Australia, Western Australian Centre for Rural Health, Geraldton, WA, Australia.
University of Melbourne · AUSt Vincent's Hospital · AUArthritis Australia · AUCurtin University · AUUniversity of Otago · NZUniversity of Western Australia · AU

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundGout is the most common inflammatory arthritis, increasing in prevalence and burden. Of the rheumatic diseases, gout is the best-understood and potentially most manageable condition. However, it frequently remains untreated or poorly managed. The purpose of this systematic review is to identify Clinical Practice Guidelines (CPG) regarding gout management, evaluate their quality, and to provide a synthesis of consistent recommendations in the high-quality CPGs.

methodsGout management CPGs were eligible for inclusion if they were (1) written in English and published between January 2015-February 2022; focused on adults aged ≥ 18 years of age; and met the criteria of a CPG as defined by the Institute of Medicine; and (2) were rated as high quality on the Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument. Gout CPGs were excluded if they required additional payment to access; only addressed recommendations for the system/organisation of care and did not include interventional management recommendations; and/or included other arthritic conditions. OvidSP MEDLINE, Cochrane, CINAHL, Embase and Physiotherapy Evidence Database (PEDro) and four online guideline repositories were searched.

resultsSix CPGs were appraised as high quality and included in the synthesis. Clinical practice guidelines consistently recommended education, commencement of non-steroidal anti-inflammatories, colchicine or corticosteroids (unless contraindicated), and assessment of cardiovascular risk factors, renal function, and co-morbid conditions for acute gout management. Consistent recommendations for chronic gout management were urate lowering therapy (ULT) and continued prophylaxis recommended based on individual patient characteristics. Clinical practice guideline recommendations were inconsistent on when to initiate ULT and length of ULT, vitamin C intake, and use of pegloticase, fenofibrate and losartan.

conclusionManagement of acute gout was consistent across CPGs. Management of chronic gout was mostly consistent although there were inconsistent recommendations regarding ULT and other pharmacological therapies. This synthesis provides clear guidance that can assist health professionals to provide standardised, evidence-based gout care.

trial registrationThe protocol for this review was registered with Open Science Framework (DOI https://doi.org/10.17605/OSF.IO/UB3Y7 ).

Indexed as

Evidence-based careEvidence-based Medicine.GoutPractice guidelines

Identifiers

PMID37316871
PMCPMC10268528
OpenAlexW4380686838

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.