LoE | GoR | SoR | ||
---|---|---|---|---|
Overarching principles | ||||
A | Gout is a chronic and serious disease with impaired quality of life and reduced life expectancy that can be treated effectively. | 9.5±0.9 | ||
B | Reducing and maintaining serum urate below a defined target is mandatory to eliminate urate crystals and improve patient outcomes. | – | – | 9.8±0.7 |
C | Successful management of gout requires education about all aspects of the disease and full involvement of the patient in shared decision-making. | – | – | 9.7±0.7 |
D | Long-term adherence to urate-lowering therapy is essential for an optimal outcome. | – | – | 9.4±0.8 |
Recommendations | ||||
1 | Serum urate must be measured regularly and urate-lowering therapy should be adjusted to attain the therapeutic target. | 2 | B | 9.8±0.6 |
2 | A serum urate level <6 mg/dL (<360 µmol/L) should be targeted and maintained in all patients with gout | 1 | A | 9.5±0.9 |
3 | In patients with severe gout, such as those with tophi or frequent attacks, the target should be a serum urate level <5 mg/dL (<300 µmol/L) until clinical remission is achieved | 5 | D | 9.2±1.5 |
4 | Acute attacks should be treated promptly with anti-inflammatory medications, taking safety issues into consideration | 5 | D | 9.9±0.5 |
5 | Prophylaxis against attacks should be initiated and continued for at least 6 months after starting urate-lowering therapy. | 5 | D | 8.3±1.7 |
6 | In all patients with gout, renal function should be assessed at the time of diagnosis and then monitored regularly. | 5 | D | 9.6±0.7 |
7 | Comorbidities associated with gout may influence therapy and outcomes and should be assessed regularly and managed | 5 | D | 9.5±0.8 |
8 | Modifiable risk factors should be addressed primarily through patient education and support. | 5 | D | 9.2±1.5 |
9 | Information about gout and its management should be made readily available to patients by their healthcare professionals. | 5 | D | 9.7±0.7 |
SoR on a 0–10 scale with 0=no agreement at all and 10=very strong agreement.
GoR, grade of recommendation; LoE, level of evidence; SoR, strength of recommendation.