目的:比较和分析全球痛风临床实践指南(CPGs)的建议,检查CPG之间的一致性,并提供制定和更新痛风指南的建议。
方法:我们在MEDLINE中进行了系统搜索,CBM,GIN,Nice,NGC,WHO,SIGN,DynaMed,UpToDate,和最佳实践数据库,从成立到2019年8月,确定和选择与痛风相关的CPG。我们使用了搜索术语“痛风”,“高尿酸血症”和“指南”。经过两轮筛选,我们根据预定义的纳入和排除标准纳入了痛风的合格CPG.用AGREE-II工具评估纳入指南的方法学质量。提取了纳入指南的一般特征和建议,并比较和分析了各指南建议的一致性。
结果:共检索到15条痛风指南,包括359条建议。建议涵盖的主要主题是诊断,痛风耀斑的药物治疗,慢性痛风性关节炎的降尿酸药物治疗(ULT),生活方式干预,预防,和无症状高尿酸血症的管理。AGREE-II评估结果表明,只有两个指南在所有六个领域都获得了高分(≥50%)。在涵盖计算机断层扫描(CT)和X射线诊断价值的建议中,指南之间存在很大差异。使用皮质类固醇作为耀斑的一线治疗,使用秋水仙碱,ULT的适应症,使用非布索坦作为一线ULT,别嘌呤醇的给药,和ULT启动的时间。
结论:许多国家正在致力于制定痛风指南,但是更新指南的过程比世界卫生组织建议的要慢。在大多数指南中,方法质量不令人满意,和建议之间的指导方针是不一致的。
OBJECTIVE: To compare and analyse the recommendations from clinical practice
guidelines (CPGs) on gout worldwide, examine the consistency across CPGs, and provide suggestions to develop and update gout guidelines.
METHODS: We conducted systematic searches in MEDLINE, CBM, GIN, NICE, NGC, WHO, SIGN, DynaMed, UpToDate, and Best Practice databases, from their inception to August 2019 to identify and select CPGs related to gout. We used the search terms \"gout\", \"hyperuricaemia\" and \"
guideline\". After two rounds of screening, we included the eligible CPGs of gout according to the pre-defined inclusion and exclusion criteria. Methodological quality of included guidelines was assessed with the AGREE-II instrument. The general characteristics of included guidelines and the recommendations were extracted, and the consistency of recommendations across
guidelines was compared and analysed.
RESULTS: A total of 15 gout guidelines including 359 recommendations were retrieved. The main topics covered by the recommendations were diagnosis, pharmacologic treatment of gout flares, pharmacologic urate-lowering therapy (ULT) of chronic gouty arthritis, lifestyle interventions, prophylaxis, and management of asymptomatic hyperuricaemia. The results of AGREE-II appraisal showed that only two guidelines achieved high scores (≥50%) in all six domains. There was substantial discrepancy between the guidelines in recommendations covering the value of computed tomography (CT) and x-rays for diagnosis, the use of corticosteroids as a first-line treatment for flare, the use of colchicine, indications for ULT, the use of febuxostat as first-line ULT, the administration of allopurinol, and the timing of ULT initiation.
CONCLUSIONS: A number of countries are devoting themselves to the development of gout guidelines, but the process of updating
guidelines is slower than that suggested by the WHO. Methodological quality is not satisfactory in most
guidelines, and recommendations between
guidelines are not consistent.