Treatment for acute flares of gout: an overview of systematic reviews_Chinese Journal of Evidence-Based Medicine

Authors：

YU Yang ¹ , ZHOU Qi ² , YANG Nang ^3,4,5 , ZHANG Jingyi ⁶ , SONG Xiaoyang ² , GAO Lingling ¹ , FENG Yingyue ¹ ,  CHEN Yaolong ^3,4,5

1. The Second Clinical Medical College of Lanzhou University, Lanzhou, 730000, P.R.China;
2. The First Clinical Medical College of Lanzhou University, Lanzhou, 730000, P.R.China;
3. Evidence-based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, 730000, P.R.China;
4. Chinese GRADE Centre, Lanzhou, 730000, P.R.China;
5. WHO Collaborating Centre for Guideline Implementation and Knowledge Translation, Lanzhou, 730000, P.R.China;
6. School of Public health, Lanzhou University, Lanzhou, 730000, P.R.China;

Corresponding author：

CHEN Yaolong, Email: guideline@chevidence.org

Keywords：

　Gout; Treatment of acute flares; Overview of systematic review; AMSTAR tool; GRADE

DOI：

10.7507/1672-2531.201805026

Video：

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ObjectivesTo evaluate the methodological bias and the reliability of the conclusions of systematic reviews (SRs) on the treatment for acute gout.MethodsPubMed, EMbase, The Cochrane Library, Epistemonikos, CBM, WanFang Data and CNKI databases were electronically searched to collect published systematic reviews and meta-analyses evaluating drug interventions therapy in acute gout from inception to April 8^th 2017. Two reviewers independently screened literature, extracted data, assessed the methodological quality of included SRs by the AMSTAR tool, and assessed the quality of the body of evidence for each outcome by the GRADE approach.ResultsA total of seven relevant SRs were included, which contains three main outcome measures. Four SRs contained non-steroidal anti-inflammatory drugs (NSAIDS), three SRs contained colchicine and two SRs contained glucocorticoids. All SRs assessed risk of bias of included original studies. Two used the Jadad scale or modified Jadad scale in this assessment while others used the " assessing risk of bias” tool recommended by Cochrane Collaboration. The assessment results of AMSTAR tool suggested that: three SRs were considered high quality (scores≥9), and the other four were considered moderate quality. GRADE results showed: the quality of the evidence of 11 outcomes was low or very low, and five outcomes was moderate.ConclusionsThe current evidence confirms the effectiveness and safety of several drug interventions in the treatment of acute gout, however, the priority of these drugs is still unclear. We suggest conducting new SRs and updating relevant SRs, to systematically compare different drug interventions therapy in acute gout with the latest evidence. In addition, we still expect to put more efforts in conducting high-quality original studies, in order to fill the gap of relevant fields and improve the level of evidence quality.

Citation： YU Yang, ZHOU Qi, YANG Nang, ZHANG Jingyi, SONG Xiaoyang, GAO Lingling, FENG Yingyue, CHEN Yaolong. Treatment for acute flares of gout: an overview of systematic reviews. Chinese Journal of Evidence-Based Medicine, 2018, 18(10): 1080-1085. doi: 10.7507/1672-2531.201805026 Copy

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2.	Juraschek SP, Miller ER 3rd, Gelber AC. Body mass index, obesity, and prevalent gout in the United States in 1988-1994 and 2007-2010. Arthritis Care Res (Hoboken), 2013, 65(1): 127-132.
3.	Kuo CF, Grainge MJ, Mallen C, et al. Rising burden of gout in the UK but continuing suboptimal management: a nationwide population study. Ann Rheum Dis, 2015, 74(4): 661-667.
4.	Robinson PC, Taylor WJ, Merriman TR. Systematic review of the prevalence of gout and hyperuricaemia in Australia. Intern Med J, 2012, 42(9): 997-1007.
5.	Winnard D, Wright C, Taylor WJ, et al. National prevalence of gout derived from administrative health data in Aotearoa. New Zealand. Rheumatology (Oxford), 2012, 51(5): 901-909.
6.	刘雅莉, 袁金秋, 杨克虎, 等. 系统评价再评价的制作方法简介及相关资料分析. 中国循证儿科杂志, 2011, 6(1): 58-64.
7.	杨克虎, 刘雅莉, 袁金秋, 等. 发展和完善中的系统评价再评价. 中国循证儿科杂志, 2011, 6(1): 54-57.
8.	Shea BJ, Grimshaw JM, Wells GA, et al. Development of AMSTAR: a measurement tool to assess the methodological quality of systematic reviews. BMC Med Res Methodol, 2007, 7: 10.
9.	Schünemann HJ, Oxman AD, Brozek J, et al. Grading quality of evidence and strength of recommendations for diagnostic tests and strategies. BMJ, 2008, 336(7653): 1106-1110.
10.	陈耀龙, 姚亮, 杜亮, 等. GRADE在系统评价中应用的必要性及注意事项. 中国循证医学杂志, 2013, 13(12): 1401-1404.
11.	Sivera F, Wechalekar MD, Andrés M, et al. Interleukin-1 inhibitors for acute gout. Cochrane Database Syst Rev, 2014, (9): CD009993.
12.	van Durme CM, Wechalekar MD, Buchbinder R, et al. Non-steroidal anti-inflammatory drugs for acute gout. Cochrane Database Syst Rev, 2014, (9): CD010120.
13.	van Echteld I, Wechalekar MD, Schlesinger N, et al. Colchicine for acute gout. Cochrane Database Syst Rev, 2014, (8): CD006190.
14.	蒙龙, 李娟, 龙锐, 等. 小剂量与常规剂量秋水仙碱治疗急性痛风性关节炎的系统评价. 中国临床药理学与治疗学, 2014, 19(6): 656-662.
15.	濮永杰, 孔卫东, 徐珽. 不同剂量秋水仙碱治疗急性痛风疗效的Meta分析. 中国药业, 2015, (16): 21-24.
16.	Zhang S, Zhang Y, Liu P, et al. Efficacy and safety of etoricoxib compared with NSAIDs in acute gout: a systematic review and a meta-analysis. Clin Rheumatol, 2016, 35(1): 151-158.
17.	杨晓燕. 依托考昔治疗急性痛风性关节炎疗效及安全性的Meta分析. 石家庄: 河北医科大学, 2016.
18.	Seo HJ, Kim KU. Quality assessment of systematic reviews or meta-analyses of nursing interventions conducted by Korean reviewers. BMC Med Res Methodol, 2012, 12: 129.
19.	Khanna D, Khanna PP, Fitzgerald JD, et al. 2012 American College of Rheumatology guidelines for management of gout. Part 2: therapy and antiinflammatory prophylaxis of acute gouty arthritis. Care Res (Hoboken), 2012, 64(10): 1447-1461.
20.	Qaseem A, Harris RP, Forciea MA, et al. Management of acute and recurrent gout: a clinical practice guideline from the american college of physicians. Ann Intern Med, 2017, 166(1): 58-68.
21.	Richette P, Doherty M, Pascual E, et al. 2016 updated EULAR evidence-based recommendations for the management of gout. Ann Rheum Dis, 2017, 76(1): 29-42.
22.	中华医学会风湿病学分会. 2016中国痛风诊疗指南. 中华内科杂志, 2016, 55(11): 892-899.
23.	屈云, 何俐, 刘鸣. Cochrane系统评价的基本方法. 中国临床康复, 2003, 7(4): 532-533, 536.

1. Roddy E, Doherty M. Epidemiology of gout. Arthritis Res Ther, 2010, 12(6): 223.
2. Juraschek SP, Miller ER 3rd, Gelber AC. Body mass index, obesity, and prevalent gout in the United States in 1988-1994 and 2007-2010. Arthritis Care Res (Hoboken), 2013, 65(1): 127-132.
3. Kuo CF, Grainge MJ, Mallen C, et al. Rising burden of gout in the UK but continuing suboptimal management: a nationwide population study. Ann Rheum Dis, 2015, 74(4): 661-667.
4. Robinson PC, Taylor WJ, Merriman TR. Systematic review of the prevalence of gout and hyperuricaemia in Australia. Intern Med J, 2012, 42(9): 997-1007.
5. Winnard D, Wright C, Taylor WJ, et al. National prevalence of gout derived from administrative health data in Aotearoa. New Zealand. Rheumatology (Oxford), 2012, 51(5): 901-909.
6. 刘雅莉, 袁金秋, 杨克虎, 等. 系统评价再评价的制作方法简介及相关资料分析. 中国循证儿科杂志, 2011, 6(1): 58-64.
7. 杨克虎, 刘雅莉, 袁金秋, 等. 发展和完善中的系统评价再评价. 中国循证儿科杂志, 2011, 6(1): 54-57.
8. Shea BJ, Grimshaw JM, Wells GA, et al. Development of AMSTAR: a measurement tool to assess the methodological quality of systematic reviews. BMC Med Res Methodol, 2007, 7: 10.
9. Schünemann HJ, Oxman AD, Brozek J, et al. Grading quality of evidence and strength of recommendations for diagnostic tests and strategies. BMJ, 2008, 336(7653): 1106-1110.
10. 陈耀龙, 姚亮, 杜亮, 等. GRADE在系统评价中应用的必要性及注意事项. 中国循证医学杂志, 2013, 13(12): 1401-1404.
11. Sivera F, Wechalekar MD, Andrés M, et al. Interleukin-1 inhibitors for acute gout. Cochrane Database Syst Rev, 2014, (9): CD009993.
12. van Durme CM, Wechalekar MD, Buchbinder R, et al. Non-steroidal anti-inflammatory drugs for acute gout. Cochrane Database Syst Rev, 2014, (9): CD010120.
13. van Echteld I, Wechalekar MD, Schlesinger N, et al. Colchicine for acute gout. Cochrane Database Syst Rev, 2014, (8): CD006190.
14. 蒙龙, 李娟, 龙锐, 等. 小剂量与常规剂量秋水仙碱治疗急性痛风性关节炎的系统评价. 中国临床药理学与治疗学, 2014, 19(6): 656-662.
15. 濮永杰, 孔卫东, 徐珽. 不同剂量秋水仙碱治疗急性痛风疗效的Meta分析. 中国药业, 2015, (16): 21-24.
16. Zhang S, Zhang Y, Liu P, et al. Efficacy and safety of etoricoxib compared with NSAIDs in acute gout: a systematic review and a meta-analysis. Clin Rheumatol, 2016, 35(1): 151-158.
17. 杨晓燕. 依托考昔治疗急性痛风性关节炎疗效及安全性的Meta分析. 石家庄: 河北医科大学, 2016.
18. Seo HJ, Kim KU. Quality assessment of systematic reviews or meta-analyses of nursing interventions conducted by Korean reviewers. BMC Med Res Methodol, 2012, 12: 129.
19. Khanna D, Khanna PP, Fitzgerald JD, et al. 2012 American College of Rheumatology guidelines for management of gout. Part 2: therapy and antiinflammatory prophylaxis of acute gouty arthritis. Care Res (Hoboken), 2012, 64(10): 1447-1461.
20. Qaseem A, Harris RP, Forciea MA, et al. Management of acute and recurrent gout: a clinical practice guideline from the american college of physicians. Ann Intern Med, 2017, 166(1): 58-68.
21. Richette P, Doherty M, Pascual E, et al. 2016 updated EULAR evidence-based recommendations for the management of gout. Ann Rheum Dis, 2017, 76(1): 29-42.
22. 中华医学会风湿病学分会. 2016中国痛风诊疗指南. 中华内科杂志, 2016, 55(11): 892-899.
23. 屈云, 何俐, 刘鸣. Cochrane系统评价的基本方法. 中国临床康复, 2003, 7(4): 532-533, 536.

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Treatment for acute flares of gout: an overview of systematic reviews

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