Evidence map›Paper›PMID 40990669›Full record

ArticleInternational journal of surgery (London, England)2026

Tophus severity grading and surgical treatment: Chinese Medical Doctor Association Multidisciplinary Expert Consensus Statement and Recommendations, 2025.

Yunchuan Pan, Shishuai Lin, Nanfang Pan, Shaowen Cheng, Jiangling Yao, Ping Liang, Xueqin Yan, Juan Li, Zunhong Liang, Zhihu Lin and 16 more

Abstract readConsensus Statement
PubMed Full text at PMC Publisher
In one paragraph

Article in International journal of surgery (London, England), 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
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

1 citing paper in PubMed.

  1. 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

26 authors.

Yunchuan PanHainan Affiliated Hospital of Hainan Medical University (Hainan Province Wound Repair Center, Department of Bone and Joint Surgery, Medical Imaging Center, Department of Rheumatology and Immunology, Nursing and Wound Management), Haikou, China.ORCID 0009-0007-9958-8180
Shishuai LinHainan Affiliated Hospital of Hainan Medical University (Hainan Province Wound Repair Center, Department of Bone and Joint Surgery, Medical Imaging Center, Department of Rheumatology and Immunology, Nursing and Wound Management), Haikou, China.
Nanfang PanHainan Affiliated Hospital of Hainan Medical University (Hainan Province Wound Repair Center, Department of Bone and Joint Surgery, Medical Imaging Center, Department of Rheumatology and Immunology, Nursing and Wound Management), Haikou, China.
Shaowen ChengDepartment of Wound Repair, Department of Medical Imaging, Department of Rheumatology and Immunology, The First Affiliated Hospital of Hainan Medical University, Haikou, China.ORCID 0009-0000-5834-3338
Jiangling YaoDepartment of Wound Repair, Department of Medical Imaging, Department of Rheumatology and Immunology, The First Affiliated Hospital of Hainan Medical University, Haikou, China.
Ping LiangHainan Affiliated Hospital of Hainan Medical University (Hainan Province Wound Repair Center, Department of Bone and Joint Surgery, Medical Imaging Center, Department of Rheumatology and Immunology, Nursing and Wound Management), Haikou, China.
Xueqin YanEvidence Application Center, Affiliated Hospital of Jiangsu University, Zhenjiang, Jiangsu, China.
Juan LiDepartment of Wound Repair, Department of Medical Imaging, Department of Rheumatology and Immunology, The First Affiliated Hospital of Hainan Medical University, Haikou, China.
Zunhong LiangHainan Affiliated Hospital of Hainan Medical University (Hainan Province Wound Repair Center, Department of Bone and Joint Surgery, Medical Imaging Center, Department of Rheumatology and Immunology, Nursing and Wound Management), Haikou, China.ORCID 0000-0002-1664-5298
Zhihu LinHainan Affiliated Hospital of Hainan Medical University (Hainan Province Wound Repair Center, Department of Bone and Joint Surgery, Medical Imaging Center, Department of Rheumatology and Immunology, Nursing and Wound Management), Haikou, China.
Zhiyang QiuHainan Affiliated Hospital of Hainan Medical University (Hainan Province Wound Repair Center, Department of Bone and Joint Surgery, Medical Imaging Center, Department of Rheumatology and Immunology, Nursing and Wound Management), Haikou, China.
Lei BaoEvidence Application Center, Affiliated Hospital of Jiangsu University, Zhenjiang, Jiangsu, China.
Leiyuan ZhongEvidence Application Center, Affiliated Hospital of Jiangsu University, Zhenjiang, Jiangsu, China.
Shudian LinHainan Affiliated Hospital of Hainan Medical University (Hainan Province Wound Repair Center, Department of Bone and Joint Surgery, Medical Imaging Center, Department of Rheumatology and Immunology, Nursing and Wound Management), Haikou, China.ORCID 0000-0003-2091-2413
Feng ZhanHainan Affiliated Hospital of Hainan Medical University (Hainan Province Wound Repair Center, Department of Bone and Joint Surgery, Medical Imaging Center, Department of Rheumatology and Immunology, Nursing and Wound Management), Haikou, China.
Yang ChenHainan Affiliated Hospital of Hainan Medical University (Hainan Province Wound Repair Center, Department of Bone and Joint Surgery, Medical Imaging Center, Department of Rheumatology and Immunology, Nursing and Wound Management), Haikou, China.
Bingyan LiuHainan Affiliated Hospital of Hainan Medical University (Hainan Province Wound Repair Center, Department of Bone and Joint Surgery, Medical Imaging Center, Department of Rheumatology and Immunology, Nursing and Wound Management), Haikou, China.
Shishi LuoHainan Affiliated Hospital of Hainan Medical University (Hainan Province Wound Repair Center, Department of Bone and Joint Surgery, Medical Imaging Center, Department of Rheumatology and Immunology, Nursing and Wound Management), Haikou, China.
Long MiDepartment of Wound Repair, Department of Medical Imaging, Department of Rheumatology and Immunology, The First Affiliated Hospital of Hainan Medical University, Haikou, China.
Hengjie ZhuDepartment of Wound Repair, Department of Medical Imaging, Department of Rheumatology and Immunology, The First Affiliated Hospital of Hainan Medical University, Haikou, China.
Guangji WangHainan Affiliated Hospital of Hainan Medical University (Hainan Province Wound Repair Center, Department of Bone and Joint Surgery, Medical Imaging Center, Department of Rheumatology and Immunology, Nursing and Wound Management), Haikou, China.
Jianping LinHainan Affiliated Hospital of Hainan Medical University (Hainan Province Wound Repair Center, Department of Bone and Joint Surgery, Medical Imaging Center, Department of Rheumatology and Immunology, Nursing and Wound Management), Haikou, China.
Yaolong ChenEvidence-based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, Gansu, China.ORCID 0000-0002-9841-5233
Xiaobing FuResearch Center for Tissue Repair and Regeneration Affiliated to PLA General Hospital, Beijing, China.ORCID 0000-0002-2465-1700
Yuesheng HuangInstitute of Wound Repair and Regeneration Medicine, Southern University of Science and Technology School of Medicine, Shenzhen, China.ORCID 0000-0003-2374-1998
CMDA Consensus Panel

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundTophi, a severe complication of advanced gout, developed in approximately 12-35% of patients with gout, with rates as high as 52.56% being reported. Bone and joint damage and chronic refractory wounds caused by gouty tophus present considerable clinical challenges. However, the optimal surgical timing, perioperative management, and treatment approaches for this condition remain unstandardized. Therefore, an expert consensus statement was developed to provide guidance for surgical intervention and improve clinical management of gouty tophus. MATERIALS AND

methodsA multidisciplinary expert committee representing relevant clinical specialties was established, and key questions on tophus surgery were compiled. Eleven scientific literature databases were queried to retrieve relevant papers, and a literature quality assessment was performed. Four meetings (nominal group technique) and two Delphi voting rounds were conducted to define tophus erosion grading criteria and establish recommendations. Consensus was considered to have been achieved when at least 85% of panelists indicated agreement. Perspectives from two patients with tophi were incorporated through interviews.

resultsGrading criteria (grades 1-4) for tophus erosion damage were established, and 14 recommendations for surgical treatment (eight strongly recommended and six conditional) were formulated - two on determining tophus erosion severity, four on perioperative management, and eight on surgical indications and treatment.

conclusionThis study presents the first consensus to introduce standardized criteria for grading tophus severity through multidisciplinary collaboration and offers evidence-based recommendations on optimal surgical timing, perioperative management, and treatment strategies to enhance patient outcomes and guide clinical practice. These recommendations may serve as a foundation for future research and standardization efforts in the surgical management of gouty tophus globally.

Indexed as

GoutChinaDelphi TechniqueHumansSeverity of Illness Indexconsensusgouty tophirecommendationsseverity gradingsurgical treatment

Identifiers

PMID40990669
PMCPMC12825664

What OpenQuestion holds

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LicenceCC BY
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Registered trials

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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.