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Web End = Rheumatol Int (2016) 36:17471752 DOI 10.1007/s00296-016-3579-z
Rheumatology
INTERNATIONAL
OBSERVATIONAL RESEARCH
Does the initiation of uratelowering treatment during an acute gout attack prolong the current episode and precipitate recurrent attacks: a systematic literature review
Fatma Eminaga1 Jonathan LeCarratt1 Adrian Jones1 A. Abhishek1,2
Abstract The aim of this study was to systematically review the literature on effect of initiating urate-lowering treatment (ULT) during an acute attack of gout on duration of index attack and persistence on ULT. OVID (Med-line), EMBASE and AMED were searched to identify randomized controlled trials (RCTs) of ULT initiation during acute gout attack published in English language. Two reviewers appraised the study quality and extracted data independently. Standardized mean difference (SMD) and relative risk (RR) were used to pool continuous and categorical data. Meta-analysis was carried out using STATA version 14. A total of 537 studies were selected. A total of 487 titles and abstracts were reviewed after removing duplicates. Three RCTs were identied. There was evidence from two high-quality studies that early initiation of allopurinol did not increase pain severity at days 1015 [SMDpooled (95 % CI) 0.18 (0.58, 0.93)]. Data from three
studies suggested that initiation of ULT during an acute attack of gout did not associate with dropouts [RRpooled
(95 % CI) 1.16 (0.58, 2.31)]. There is moderate-quality evidence that the initiation of ULT during an acute attack of gout does not increase pain severity and risk of ULT discontinuation. Larger studies are required to conrm these
Received: 18 June 2016 / Accepted: 12 October 2016 / Published online: 19 October 2016 The Author(s) 2016. This article is published with open access at Springerlink.com
ndings so that patients with acute gout can be initiated on ULT with condence.
Keywords Acute gout Urate-lowering treatment
Systematic review
Introduction
Gout is the commonest inammatory arthritis and results from monosodium urate (MSU) crystal deposition. It is the only arthritis that has the potential of being cured if the serum uric acid is reduced to <360 mol/L persistently with effective urate-lowering treatment (ULT) [1]. Guidelines for the management of gout recommend that patients continue on ULT during a gout attack, but provide conicting recommendations on whether ULT can be started during an acute attack [13]. For...