2020 American College of Rheumatology Guideline for the Management of Gout
2020 American College of Rheumatology Guideline for the Management of Gout
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DOI：
10.1002/art.41247
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发表时间：
2020-05-11
影响因子：
13.3
通讯作者：
Neogi, Tuhina
中科院分区：
文献类型：
--
作者：
FitzGerald, John D.;Dalbeth, Nicola;Neogi, Tuhina
目的为痛风的治疗提供指导，包括降尿酸治疗（urate-reducing therapy，URH）的适应症和最佳使用、痛风发作的治疗、生活方式和其他药物建议。方法开发了57个人群、干预、对照和结局问题，随后进行了系统的文献综述。包括网络荟萃分析，根据推荐分级评估、开发和评价（GRADE）方法和患者输入对现有证据进行评级。一组共识的过程是用来组成的最终建议和等级的强度为强或conditional.Results四十二个建议（包括16个强建议）产生。强烈的建议包括：对痛风石样痛风、痛风引起的放射学损害或频繁发作的痛风患者开始使用别嘌呤醇;别嘌呤醇作为首选的一线治疗药物，包括对中重度慢性肾脏疾病（CKD;分期>3）的患者;使用低起始剂量的别嘌呤醇（
Objective To provide guidance for the management of gout, including indications for and optimal use of urate-lowering therapy (ULT), treatment of gout flares, and lifestyle and other medication recommendations.Methods Fifty-seven population, intervention, comparator, and outcomes questions were developed, followed by a systematic literature review, including network meta-analyses with ratings of the available evidence according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology, and patient input. A group consensus process was used to compose the final recommendations and grade their strength as strong or conditional.Results Forty-two recommendations (including 16 strong recommendations) were generated. Strong recommendations included initiation of ULT for all patients with tophaceous gout, radiographic damage due to gout, or frequent gout flares; allopurinol as the preferred first-line ULT, including for those with moderate-to-severe chronic kidney disease (CKD; stage >3); using a low starting dose of allopurinol (