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2016 updated EULAR evidence-based recommendations for the management of gout
  1. P Richette1,
  2. M Doherty2,
  3. E Pascual3,
  4. V Barskova4,
  5. F Becce5,
  6. J Castañeda-Sanabria6,
  7. M Coyfish7,
  8. S Guillo6,
  9. T L Jansen8,
  10. H Janssens9,
  11. F Lioté1,
  12. C Mallen10,
  13. G Nuki11,
  14. F Perez-Ruiz12,
  15. J Pimentao13,
  16. L Punzi14,
  17. T Pywell7,
  18. A So15,
  19. A K Tausche16,
  20. T Uhlig17,
  21. J Zavada18,
  22. W Zhang2,
  23. F Tubach6,
  24. T Bardin1
  1. 1AP-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
  2. 2Academic Rheumatology, University of Nottingham, Nottingham, UK
  3. 3Department of Rheumatology, Hospital General Universitario de Alicante, Alicante, Spain
  4. 4Institute of Rheumatology RAMS, Moscow, Russia
  5. 5Department of Diagnostic and Interventional Radiology, Lausanne University Hospital, Lausanne, Switzerland
  6. 6AP-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
  7. 7Patient from Nottingham, UK, Paris
  8. 8Department of Rheumatology, VieCuri Medical Centre, Venlo, and Scientific IQ HealthCare, Radboud UMC, Nijmegen, The Netherlands
  9. 9Department of Primary and Community Care, Radboud University Medical Centre, Nijmegen, Netherlands
  10. 10Arthritis Research UK Primary Care Centre University of Keele, Keele, UK
  11. 11Osteoarticular Research Group, University of Edinburgh, Edinburgh, UK
  12. 12Seccion de Rheumatologia, Hospital de Cruces, Baracaldo, Spain
  13. 13Rheumatology Unit, Clínica Coração de Jesus, Lisbon, Portugal
  14. 14Rheumatology Unit, University of Padova, Padova, Italy
  15. 15Service de Rhumatologie, CHUV and Universitè de Lausanne, Lausanne, Switzerland
  16. 16Department of Rheumatology, University Clinic at the Technical University Dresden, Germany
  17. 17Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
  18. 18Institute of Rheumatology, Prague, and Department of Rheumatology, First Faculty of Medicine, Charles University in Prague, Czech Republic
  1. Correspondence to Professor Pascal Richette, Fédération de Rhumatologie, Centre Viggo Petersen, Hôpital Lariboisière, 2 rue Ambroise Paré, Paris 75010, France; pascal.richette{at}aphp.fr

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.

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Footnotes

  • Contributors All authors have contributed to this work and approved the final version.

  • Competing interests PR received fees from Ipsen Pharma/Menarini, AstraZeneca and Savient. MD has received honoraria for ad hoc advisory boards on gout or osteoarthritis from Ardea BioSciences, AstraZeneca, Nordic BioSciences and Roche and CI for a Nottingham University Investigator-led non-drug study on gout funded by AstraZeneca. EP received fees from Ipsen Pharma/Menarini and AstraZeneca. TLJ received fees for lectures and/or advisory boards from AstraZeneca, AbbVie, BMS, Janssen, Eli Lilly, Menarini, Novartis, Pfizer, Roche, UCB. FL received fees for advisory boards: Ardea BioSciences, AstraZeneca global, AstraZeneca France, Ipsen Pharma, Menarini International, Menarini France, Novartis France, Novartis Global, Savient, Mayoly Spindler. He also had unrestricted grants for organising the European Crystal Workshops (Convenor Frédéric Lioté, France & Alexander SO, Switzerland) since 2010: Ardea BioSciences, AstraZeneca global, AstraZeneca France, Ipsen Pharma, Novartis France, Novartis Global, Mayoly Spindler, Savient, SOBI France, SOBI International. He received fees for lectures from Ardea BioSciences, Ipsen Pharma, Menarini France, Novartis Global. GN received fees from Savient, Ipsen and Menarini. FP-R has received fees from Ipsen Pharma, Menarini and AstraZeneca. LP has received consulting or speaker fees from Menarini, Fidia, AbbVie, Merck. AS has served as consultant to AstraZeneca and SOBI in regards to the treatment of gout. AKT received fees from Berlin Chemie-Menarini, Novartis and AstraZeneca/Ardea BioSciences. TU received fees from Novartis and AstraZeneca/Ardea. JZ received fees from Berlin Chemie-Menarini and Novartis, both <US$1000. WZ received honorarium from Savient as part of the Advisory Board for Pegloticase. TB has received consulting fees, speaker fees or grants from Ipsen Pharma, Menarini, AstraZeneca, Novartis, SOBI, Savient and CymaBay.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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