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Extended report
Treat-to-target (T2T) recommendations for gout
  1. U Kiltz1,
  2. J Smolen2,
  3. T Bardin3,
  4. A Cohen Solal4,
  5. N Dalbeth5,
  6. M Doherty6,
  7. B Engel7,
  8. C Flader1,
  9. J Kay8,
  10. M Matsuoka9,
  11. F Perez-Ruiz10,
  12. G da Rocha Castelar-Pinheiro11,
  13. K Saag12,
  14. A So13,
  15. J Vazquez Mellado14,
  16. M Weisman15,
  17. T H Westhoff16,
  18. H Yamanaka17,
  19. J Braun1
  1. 1Rheumazentrum Ruhrgebiet, and Ruhr University Bochum, Herne, Germany
  2. 2Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, Vienna, Austria
  3. 3Assisitance Publique Hôpitaux de Paris Rheumatology Department, Lariboisière Hospital, University Paris Diderot, Sorbonne Paris-Cité and INSERM, UMR 1132, Paris, France
  4. 4Research Medical Unit INSERM, Université Paris VII—Denis Diderot Assistance Publique—Hôpitaux de Paris, Service de Cardiologie, Hôpital Lariboisière, Paris, France
  5. 5University of Auckland and Auckland District Health Board, Auckland, New Zealand
  6. 6University of Nottingham, Nottingham, UK
  7. 7Medical Faculty, Institute of General Practice and Family Medicine, University Bonn, Bonn, Germany
  8. 8UMass Memorial Medical Center and University of Massachusetts Medical School, Worcester, Massachusetts, USA
  9. 9Carnegie Mellon University, Pittsburgh, Pennsylvania, USA
  10. 10Rheumatology Division, Hospital de Cruces, Baracaldo, Vizcaya, Spain
  11. 11Discipline of Rheumatology, Rio de Janeiro State University, Rio de Janeiro, Brazil
  12. 12University of Alabama at Birmingham, Birmingham, Alabama, USA
  13. 13Service de Rhumatologie, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland
  14. 14Servicio de Reumatología, Hospital General de México, México City, México
  15. 15Division of Rheumatology, Cedars-Sinai Medical Center, David Geffen School of Medicine at UCLA, Los Angeles, USA
  16. 16Medical Department I, Marien Hospital Herne, Ruhr-University of Bochum, Herne, Germany
  17. 17Tokyo Women's Medical University, Tokyo, Japan
  1. Correspondence to Professor Juergen Braun, Rheumazentrum Ruhrgebiet, Herne D-44652, Germany; juergen.braun{at}elisabethgruppe.de

Abstract

Objectives The treat-to-target (T2T) concept has been applied successfully in several inflammatory rheumatic diseases. Gout is a chronic disease with a high burden of pain and inflammation. Because the pathogenesis of gout is strongly related to serum urate levels, gout may be an ideal disease in which to apply a T2T approach. Our aim was to develop international T2T recommendations for patients with gout.

Methods A committee of experts with experience in gout agreed upon potential targets and outcomes, which was the basis for the systematic literature search. Eleven rheumatologists, one cardiologist, one nephrologist, one general practitioner and one patient met in October 2015 to develop T2T recommendations based on the available scientific evidence. Levels of evidence, strength of recommendations and levels of agreement were derived.

Results Although no randomised trial was identified in which a comparison with standard treatment or an evaluation of a T2T approach had been performed in patients with gout, indirect evidence was provided to focus on targets such as normalisation of serum urate levels. The expert group developed four overarching principles and nine T2T recommendations. They considered dissolution of crystals and prevention of flares to be fundamental; patient education, ensuring adherence to medications and monitoring of serum urate levels were also considered to be of major importance.

Conclusions This is the first application of the T2T approach developed for gout. Since no publication reports a trial comparing treatment strategies for gout, highly credible overarching principles and level D expert recommendations were created and agreed upon.

  • Gout
  • Treatment
  • Qualitative research

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