Article Text

Multinational evidence-based recommendations for the diagnosis and management of gout: integrating systematic literature review and expert opinion of a broad panel of rheumatologists in the 3e initiative
  1. Francisca Sivera1,
  2. Mariano Andrés2,
  3. Loreto Carmona3,
  4. Alison S R Kydd4,
  5. John Moi5,
  6. Rakhi Seth6,
  7. Melonie Sriranganathan6,
  8. Caroline van Durme7,8,
  9. Irene van Echteld9,
  10. Ophir Vinik10,
  11. Mihir D Wechalekar11,
  12. Daniel Aletaha12,
  13. Claire Bombardier13,14,
  14. Rachelle Buchbinder15,16,
  15. Christopher J Edwards6,
  16. Robert B Landewé9,17,
  17. Johannes W Bijlsma18,
  18. Jaime C Branco19,20,
  19. Rubén Burgos-Vargas21,
  20. Anca I Catrina22,
  21. Dirk Elewaut23,
  22. Antonio J L Ferrari24,
  23. Patrick Kiely25,
  24. Burkhard F Leeb26,
  25. Carlomaurizio Montecucco27,
  26. Ulf Müller-Ladner28,
  27. Mikkel Østergaard29,
  28. Jane Zochling30,
  29. Louise Falzon31,
  30. Désirée M van der Heijde32
  1. 1Department Reumatologia, Hospital General Universitario de Elda, Elda, Spain
  2. 2Department Reumatologia, Hospital General Universitario de Alicante, Alicante, Spain
  3. 3Facultad de Ciencias de la Salud, Universidad Camilo Jose Cela, Madrid, Spain
  4. 4Division of Rheumatology, University of British Columbia, Vancouver, British Columbia, Canada
  5. 5Royal Melbourne Hospital, Parkville, Australia
  6. 6University Hospital Southampton NHS Foundation Trust & NIHR Wellcome Trust Clinical Research Facility, Southampton, UK
  7. 7Centre Hospitalier Universitaire de Liège, Liège, Belgium
  8. 8Department of Internal Medicine/Rheumatology, Maastricht University Medical Centre, Maastricht, The Netherlands
  9. 9Atrium Medical Centre, Heerlen, The Netherlands
  10. 10Division of Rheumatology, University of Toronto, Toronto, Ontario, Canada
  11. 11Rheumatology Research Unit, Repatriation General Hospital and Flinders University, Adelaide, Australia
  12. 12Division of Rheumatology, Department of Internal Medicine 3, Medical University of Vienna, Vienna, Austria
  13. 13Division of rheumatology and Department of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
  14. 14Division of Clinical Decision Making and Health Care, Toronto General Research Institute, University Health Network, Mount Sinai Hospital, Toronto, Ontario, Canada
  15. 15Monash Department of Clinical Epidemiology, Cabrini Hospital, Malvern, Victoria, Australia
  16. 16Department of Epidemiology and Preventive Medicine, Monash University, Malvern, Victoria, Australia
  17. 17Department of Clinical Immunology and Rheumatology, Academic Medical Center/University of Amsterdam, Amsterdam, The Netherlands
  18. 18Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
  19. 19CEDOC, Faculdade Ciências Médicas, Universidade Nova de Lisboa, Lisboa, Portugal
  20. 20Rheumatology Department, CHLO, EPE—Hospital Egas Moniz, Lisboa, Portugal
  21. 21Rheumatology Unit, Hospital General de México, Mexico City, Mexico
  22. 22Department of Rheumatology, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden
  23. 23Department of Rheumatology, Ghent University Hospital, Ghent, Belgium
  24. 24Rheumatology Division, Universidade Federal de São Paulo, São Paulo-SP, Brazil
  25. 25Department of Rheumatology, St George's Healthcare NHS Trust, London, UK
  26. 26State Hospital Stockerau, Center for Rheumatology, Lower Austria, Stockerau, Austria
  27. 27Cattedra di Reumatologia, IRCCS Policlinico S. Matteo, Università di Pavia, Pavia, Italy
  28. 28Department of Rheumatology and Clinical Immunology, Justus-Liebig-University, Kerckhoff Klinik, Bad Nauheim, Germany
  29. 29Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Copenhagen University Hospitals at Glostrup, Glostrup, Denmark
  30. 30Menzies Research Institute Tasmania, Hobart, Australia
  31. 31Columbia University Medical Center, New York, New York, USA
  32. 32Leiden University Medical Center, Leiden, The Netherlands
  1. Correspondence to Dr Francisca Sivera, Department Reumatologia, Hospital General Universitario de Elda, Elda 03600, Spain; fransimas{at}


We aimed to develop evidence-based multinational recommendations for the diagnosis and management of gout. Using a formal voting process, a panel of 78 international rheumatologists developed 10 key clinical questions pertinent to the diagnosis and management of gout. Each question was investigated with a systematic literature review. Medline, Embase, Cochrane CENTRAL and abstracts from 2010–2011 European League Against Rheumatism and American College of Rheumatology meetings were searched in each review. Relevant studies were independently reviewed by two individuals for data extraction and synthesis and risk of bias assessment. Using this evidence, rheumatologists from 14 countries (Europe, South America and Australasia) developed national recommendations. After rounds of discussion and voting, multinational recommendations were formulated. Each recommendation was graded according to the level of evidence. Agreement and potential impact on clinical practice were assessed. Combining evidence and clinical expertise, 10 recommendations were produced. One recommendation referred to the diagnosis of gout, two referred to cardiovascular and renal comorbidities, six focused on different aspects of the management of gout (including drug treatment and monitoring), and the last recommendation referred to the management of asymptomatic hyperuricaemia. The level of agreement with the recommendations ranged from 8.1 to 9.2 (mean 8.7) on a 1–10 scale, with 10 representing full agreement. Ten recommendations on the diagnosis and management of gout were established. They are evidence-based and supported by a large panel of rheumatologists from 14 countries, enhancing their utility in clinical practice.

  • Gout
  • Treatment
  • Synovial fluid

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