Background Weight loss is a commonly recommended treatment for gout, but the magnitude of effect to expect has to our knowledge not previously been evaluated in a systematic review.
Objectives The aim of this systematic review was to determine the benefits and harms associated with weight loss in overweight patients with gout.
Methods Based on a pre-defined protocol (CRD42016037937), we searched six databases for longitudinal studies, quantitatively reporting the effect of weight loss in overweight gout patients. Risk of bias was assessed using the ROBINS-I tool. The quality of the evidence was assessed using GRADE.
Results From 3,991 potentially eligible studies, 10 were included (incl. one RCT). Interventions included diet with/without physical activity, bariatric surgery, diuretics, metformin, or no intervention. Due to clinical heterogeneity of the included studies, data are presented for each study and synthesised separately. The effect on serum uric acid (sUA) ranged from -168 to 30 μmol/L, and 0% to 60% patients achieved sUA normalisation (i.e. sUA <360 μmol/L). Six out of eight studies (75%) showed beneficial effects on gout attacks. A dose-response relationship was indicated in two studies for sUA, sUA normalisation and gout attacks. At short term (<3 months) after bariatric surgery, one study showed temporary increase in sUA, and another showed temporary increased number of gout attacks. Other possible harmful effects, measured by proxies such as withdrawals due to adverse events and serious adverse events, were poorly reported.
Conclusions The available evidence is in favour of weight loss for overweight gout patients, with low, moderate and low quality of evidence for an effect on sUA, sUA normalisation, and gout attacks, respectively. At short term, temporary increased sUA and gout attacks may occur after bariatric surgery. There is an urgent need to initiate rigorous prospective studies (preferably RCTs) to provide more trustworthy estimates of benefits and harms of weight loss in overweight gout patients.
Richette P, Doherty M, Pascual E, et al. 2016 updated EULAR evidence-based recommendations for the management of gout. Ann Rheum Dis 2016:1–14, doi: 10.1136/annrheumdis-2016-209707.
Disclosure of Interest None declared