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Diagnosis and treatment for hyperuricemia and gout: a systematic review of clinical practice guidelines and consensus statements
  1. Qianrui Li1,2,
  2. Xiaodan Li3,
  3. Jing Wang4,
  4. Hongdie Liu1,
  5. Joey Sum-Wing Kwong5,
  6. Hao Chen6,
  7. Ling Li7,
  8. Sheng-Chia Chung2,
  9. Anoop Shah2,8,9,10,
  10. Yaolong Chen11,
  11. Zhenmei An1,
  12. Xin Sun7,
  13. Harry Hemingway2,9,10,
  14. Haoming Tian1,
  15. Sheyu Li1,12
  1. 1 Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, China
  2. 2 Institute of Health Informatics, University College London, London, UK
  3. 3 Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu, China
  4. 4 Department of Oto-Rhino-Laryngology, West China Hospital, Sichuan University, Chengdu, China
  5. 5 Jockey Club School of Public Health and Primary Care, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
  6. 6 The Second Clinical College, Nanjing University of Chinese Medicine, Nanjing, China
  7. 7 Chinese Evidence-Based Medicine Center, West China Hospital, Sichuan University, Chengdu, China
  8. 8 Farr Institute of Health Informatics Research, University College London, London, UK
  9. 9 Health Data Research UK London, University College London, London, UK
  10. 10 The National Institute for Health Research University College London Hospitals Biomedical Research Centre, University College London, London, UK
  11. 11 Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
  12. 12 Division of Population Health and Genomics, Ninewells Hospital and School of Medicine, University of Dundee, Dundee, United Kingdom
  1. Correspondence to Dr Sheyu Li; lisheyu{at}


Objectives Despite the publication of hundreds of trials on gout and hyperuricemia, management of these conditions remains suboptimal. We aimed to assess the quality and consistency of guidance documents for gout and hyperuricemia.

Design Systematic review and quality assessment using the appraisal of guidelines for research and evaluation (AGREE) II methodology.

Data sources PubMed and EMBASE (27 October 2016), two Chinese academic databases, eight guideline databases, and Google and Google scholar (July 2017).

Eligibility criteria We included the latest version of international and national/regional clinical practice guidelines and consensus statements for diagnosis and/or treatment of hyperuricemia and gout, published in English or Chinese.

Data extraction and synthesis Two reviewers independently screened searched items and extracted data. Four reviewers independently scored documents using AGREE II. Recommendations from all documents were tabulated and visualised in a coloured grid.

Results Twenty-four guidance documents (16 clinical practice guidelines and 8 consensus statements) published between 2003 and 2017 were included. Included documents performed well in the domains of scope and purpose (median 85.4%, range 66.7%–100.0%) and clarity of presentation (median 79.2%, range 48.6%–98.6%), but unsatisfactory in applicability (median 10.9%, range 0.0%–66.7%) and editorial independence (median 28.1%, range 0.0%–83.3%). The 2017 British Society of Rheumatology guideline received the highest scores. Recommendations were concordant on the target serum uric acid level for long-term control, on some indications for urate-lowering therapy (ULT), and on the first-line drugs for ULT and for acute attack. Substantially inconsistent recommendations were provided for many items, especially for the timing of initiation of ULT and for treatment for asymptomatic hyperuricemia.

Conclusions Methodological quality needs improvement in guidance documents on gout and hyperuricemia. Evidence for certain clinical questions is lacking, despite numerous trials in this field. Promoting standard guidance development methods and synthesising high-quality clinical evidence are potential approaches to reduce recommendation inconsistencies.

PROSPERO registration number CRD42016046104.

  • clinical practice guideline
  • hyperuricemia
  • gout
  • systematic review

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  • QL and XL are joint first authors.

  • QL and XL contributed equally.

  • Author's contributions HT and SL conceived this study. QL, JS-WK and SL designed the inclusion/exclusion criteria and the searching resource and strategy. QL, JS-WK, HC, LL and XS designed the appraisal strategy of each included guideline and consensus. QL and XL searched literature search and extracted data. QL, XL, JW, HL and SL assessed the quality of each document. QL analysed and visualised the outcomes. S-CC, AS, YC, ZA, XS and HH provided critical review. QL, XL and SL drafted the manuscript. All authors discussed actively in the protocol of the study.

  • Funding This research received no specific funding from any bodies in the public, commercial or not-for-profit sectors. AS is supported by the National Institute for Health Research (NIHR) University College London Hospitals Biomedical Research Centre and a THIS Institute postdoctoral fellowship. HH is a NIHR Senior Investigator. His work is supported by: (1) Health Data Research UK, which is funded by the UK Medical Research Council, Engineering and Physical Sciences Research Council, Economic and Social Research Council, Department of Health and Social Care (England), Chief Scientist Office of the Scottish Government Health and Social Care Directorates, Health and Social Care Research and Development Division (Welsh Government), Public Health Agency (Northern Ireland), British Heart Foundation and Wellcome Trust. (2) The BigData@Heart Consortium, funded by the Innovative Medicines Initiative-2 Joint Undertaking under grant agreement No 116074. This Joint Undertaking receives support from the European Union’s Horizon 2020 research and innovation programme and EFPIA; it is chaired, by DE Grobbee and SD Anker, partnering with 20 academic and industry partners and ESC. (3) The NIHR University College London Hospitals Biomedical Research Centre. SL was supported by grants from the National Natural Science Foundation of China (grant number 81400811 and 21534008), National Basic Research Program of China (grant number 2015CB942800), the Scientific Research Project of Health and Family Planning Commission of Sichuan Province (grant number 130029, 150149, 17PJ063 and 17PJ445), Cholesterol Fund by China Cardiovascular Foundation and China Heart House and the International Visiting Program for Excellent Young Scholars of Sichuan University.

  • Competing interests None declared.

  • Patient consent for publication Not obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data in this paper were obtained from published studies. No additional data are available from the authors.

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