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

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.	劉雅莉, 袁金秋, 楊克虎, 等. 系統評價再評價的制作方法簡介及相關資料分析. 中國循證兒科雜志, 2011, 6(1): 58-64.
7.	楊克虎, 劉雅莉, 袁金秋, 等. 發展和完善中的系統評價再評價. 中國循證兒科雜志, 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.	陳耀龍, 姚亮, 杜亮, 等. GRADE在系統評價中應用的必要性及注意事項. 中國循證醫學雜志, 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.	蒙龍, 李娟, 龍銳, 等. 小劑量與常規劑量秋水仙堿治療急性痛風性關節炎的系統評價. 中國臨床藥理學與治療學, 2014, 19(6): 656-662.
15.	濮永杰, 孔衛東, 徐珽. 不同劑量秋水仙堿治療急性痛風療效的Meta分析. 中國藥業, 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.	楊曉燕. 依托考昔治療急性痛風性關節炎療效及安全性的Meta分析. 石家莊: 河北醫科大學, 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.	中華醫學會風濕病學分會. 2016中國痛風診療指南. 中華內科雜志, 2016, 55(11): 892-899.
23.	屈云, 何俐, 劉鳴. Cochrane系統評價的基本方法. 中國臨床康復, 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. 劉雅莉, 袁金秋, 楊克虎, 等. 系統評價再評價的制作方法簡介及相關資料分析. 中國循證兒科雜志, 2011, 6(1): 58-64.
7. 楊克虎, 劉雅莉, 袁金秋, 等. 發展和完善中的系統評價再評價. 中國循證兒科雜志, 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. 陳耀龍, 姚亮, 杜亮, 等. GRADE在系統評價中應用的必要性及注意事項. 中國循證醫學雜志, 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. 蒙龍, 李娟, 龍銳, 等. 小劑量與常規劑量秋水仙堿治療急性痛風性關節炎的系統評價. 中國臨床藥理學與治療學, 2014, 19(6): 656-662.
15. 濮永杰, 孔衛東, 徐珽. 不同劑量秋水仙堿治療急性痛風療效的Meta分析. 中國藥業, 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. 楊曉燕. 依托考昔治療急性痛風性關節炎療效及安全性的Meta分析. 石家莊: 河北醫科大學, 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. 中華醫學會風濕病學分會. 2016中國痛風診療指南. 中華內科雜志, 2016, 55(11): 892-899.
23. 屈云, 何俐, 劉鳴. Cochrane系統評價的基本方法. 中國臨床康復, 2003, 7(4): 532-533, 536.

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Chinese Journal of Evidence-Based Medicine

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

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