The incidence of hyperuricemia and gout is increasing in China, and it is estimated that there are 120 million and 17 million hyperuricemia and gout respectively in the country, and the diagnosis and treatment of gout are very irregular.
In response to these key issues, more than 10 professors engaged in clinical and basic research on gout in China conducted 2 rounds of discussion, each putting forward their own views and suggestions, and reaching 15 consensus items. The professors who participated in the discussion were Cheng Zhifeng, Huang Cibo, Li Changgui, Li Juan, Lin Xiaoyi (Taiwan), Liu Xiangyuan, Song Hui, Jiang Dexun, Wu Donghai, Wu Husheng, Zeng Xuejun, Zhang Shunren, Zhao Dongbao, Zheng Yi, Zhou Jingguo, Zou Hejian, etc.
The consensus is as follows.
1, The gold standard for gout diagnosis is the finding of urate crystals in joint fluid or deposited nodules, while typical attack characteristics, effective colchicine treatment, hyperuricemia and/or dual-energy CT and ultrasonography can help in early diagnosis.
2. Before treatment of gout, it is necessary to know whether there are secondary factors and to assess the severity of the disease:
(1) Blood uric acid, 24-hour uric acid level;
(2) Arthritis: the degree of pain, the number of joints involved and whether recurrent attacks and joint destruction;
(3) The presence or absence of visible gout stones;
(4) kidney involvement;
(5) Comorbidities.
3, non-pharmacological treatment is the basis of gout treatment (patient education, exercise, weight reduction, low purine diet, quit smoking and alcohol, drink more water to maintain adequate urine output, etc.).
4.Colchicine or non-steroidal anti-inflammatory drugs are preferred for acute attacks of gout, and local glucocorticoids for joints can also be used, and topical analgesic drugs combined with oral analgesic drugs are more effective. The timing of medication is very important, the earlier the use of the better (within 24h of the attack), the course of treatment 7-10 days.
5.When NSAIDs and colchicine are not tolerated or contraindicated, oral, intramuscular, intravenous or local application of glucocorticoid can be chosen, but the duration of each use should not exceed 10 days, and long-term use is not recommended.
6.For those who have severe pain during the attack, the combination of drugs (including the combination of colchicine and hormones or non-steroidal anti-inflammatory drugs) can be used, and biological agents such as interleukin 1 antagonists can be considered for refractory patients.
7. When colchicine is used in the treatment of acute attacks, low-dose therapy is recommended (1mg at the beginning of the loading dose, 0.5mg after 1h, 0.5mg after 12h, bid/tid).
8.If gout attack >1 time or there is renal decompensation or gout stone formation, continuous uric acid-lowering drug therapy should be started, and the dose should be adjusted according to the blood uric acid value.
9.The first time to add uric acid-lowering drugs is appropriate after the acute attack of gout is relieved or after giving sufficient anti-inflammatory and analgesic drugs during the acute attack, once added, the gout will not be stopped when it attacks again.
Allopurinol, febuxostat and benzbromarone are commonly used uric acid-lowering drugs, and the dose should be increased gradually from small doses according to the patient’s renal function, the presence of gout stones and uric acid excretion.
11. To prevent the occurrence of severe hypersensitivity syndrome, it is advisable to test the HLA-B*5801 gene before using allopurinol.
12.When the efficacy of single uric acid-lowering drugs is not good, other uric acid-lowering drugs can be used in combination with other uric acid-lowering drugs, such as those that inhibit uric acid synthesis and those that promote uric acid excretion, or those that have dual functions (such as both uric acid-lowering and lipid-lowering effects).
13.Uric acid-lowering treatment should prevent the attack of gout, starting from uric acid-lowering, combined with low-dose colchicine (0.5mg, 1~2 times/d) or low-dose NSAIDs or low-dose glucocorticoids, colchicine is recommended to be preferred for 6 months.
14.The continuous achievement of uric acid reduction (<360umol/L for those without gout stones; <300umol/L for those with gout stones) is the key to gout treatment.
15.Start uric acid lowering treatment:
(1) Blood uric acid has exceeded 9mg/dl.
(2) Blood uric acid 7~9mg/dl, no cardiovascular disease or cardiovascular risk factors, diet control for 6 months is not effective (3) Blood uric acid 7mg/dl or more, cardiovascular disease or cardiovascular risk factors.