TableĀ 1

Ten clinical questions of the Evidence, Expertise, Exchange (3e) Initiative

1In which circumstances can a diagnosis of gout be made on clinical grounds with or without laboratory tests or imaging and when is the identification of crystals necessary?
2In patients with hyperuricaemia and/or the diagnosis of gout, should we screen routinely for comorbidities and CV risk factors?
3What is the role of glucocorticoids, colchicine, NSAIDs, anti-IL1 and paracetamol in the management of acute gout?
4Which lifestyle changes (such as diet, alcohol intake, weight loss, smoking and/or exercise) are efficacious in the treatment/prevention of gout?
5What is the efficacy, cost-efficacy and safety for ULT (allopurinol, but also febuxostat, peg-uricase, benzbromarone and probenecid) in the treatment of gout? Which sequence of ULT or combinations of should be recommended?
6When introducing ULT, what is the best treatment to prevent an acute attack and for how long should it be continued? When is the optimum time to start ULT after an acute attack of gout?
7How do common comorbidities (such as metabolic syndrome, CV, GI and renal disease) influence the choice of gout-specific drugs (such as colchicine, allopurinol and other ULT) in acute gout flare, chronic gout and in prophylaxis of acute flare?
8What should be the treatment target and how should patients with gout be followed (with which measures (eg, patient-reported outcomes, clinical, biochemical and/or imaging))?
9How should tophi be managed?
10Can we prevent gouty arthritis, renal disease and CV events by lowering serum uric acid levels in patients with asymptomatic hyperuricaemia? If yes, what should be the target levels?
  • CV, cardiovascular; GI, gastrointestinal; IL, interleukin; NSAID, non-steroidal anti-inflammatory drug; ULT, urate-lowering therapy.