Table 6

 Future research agenda: propositions developed through three Delphi rounds

NSAID, non-steroidal anti-inflammatory drug; SUA, serum uric acid.
1The optimal drug (colchicine or NSAID), dose, and duration for prophylaxis of acute attacks when starting urate lowering treatment, and whether this should vary in different clinical settings (for example, in the presence of tophi) needs to be determined
2Studies are required to determine the optimal dose and frequency of oral colchicine for treatment of an acute attack
3Further studies are required to determine the target SUA for urate lowering treatment that ensures crystal dissolution and eventual cure
4Direct comparison (efficacy, side effects, cost utility) between allopurinol and alternative urate lowering treatments are needed
5The efficacy and safety of combined urate lowering treatment (for example, allopurinol plus a uricosuric drug) should be determined and compared with monotherapy in patients with severe gout
6The efficacy of educational programmes for lifestyle modification (weight loss, reduced alcohol intake, restriction of dietary purines) in patients with gout needs to be assessed
7The indications for initiating urate lowering treatment (for example, recurrent acute attacks, tophi, polyarticular acute attacks, radiographic joint damage) need further evaluation
8Whether initiation of urate lowering treatment during an acute attack is disadvantageous and should be avoided, and if so for how long, requires investigation
9The possible benefits on cardiovascular disease of lowering SUA merit investigation