Management of gout and hyperuricemia: Multidisciplinary consensus in Taiwan
Kuang-Hui Yu
Division of Rheumatology, Allergy, and Immunology, Chang Gung Memorial Hospital, Chang Gung University, Taipei, Taiwan
Authors are listed in alphabetical order, except for the first and last author.Search for more papers by this authorDer-Yuan Chen
Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan
Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
Ph.D. Program in Translational Medicine, Rong Hsing Research Center for Translational Medicine, National Chung Hsing University, Taichung, Taiwan
Search for more papers by this authorJiunn-Horng Chen
Division of Immunology and Rheumatology, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
Search for more papers by this authorShih-Yang Chen
Center of Gout, Country Hospital, Taipei, Taiwan
Search for more papers by this authorShyh-Ming Chen
Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University, Kaohsiung, Taiwan
Search for more papers by this authorTien-Tsai Cheng
Division of Rheumatology, Allergy and Immunology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University, Kaohsiung, Taiwan
Search for more papers by this authorSong-Chou Hsieh
Division of Rheumatology, Immunology and Allergy, Department of Internal Medicine, National Taiwan University Hospital, Hsinchu, Taiwan
Search for more papers by this authorTsu-Yi Hsieh
Division of Allergy, Immunology, and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
Ph.D. Program of Business, Institute of Business, Feng-Chia University, Taichung, Taiwan
Search for more papers by this authorPai-Feng Hsu
Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan
Department of Healthcare and Services Center, Taipei Veterans General Hospital, Taipei, Taiwan
Search for more papers by this authorChang-Fu Kuo
Division of Rheumatology, Allergy, and Immunology, Chang Gung Memorial Hospital, Chang Gung University, Taipei, Taiwan
Search for more papers by this authorMei-Chuan Kuo
Division of Nephrology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
Faculty of Renal Care, Kaohsiung Medical University, Kaohsiung, Taiwan
Search for more papers by this authorHing-Chung Lam
Division of Endocrinology and Metabolism, Department of Internal Medicine, E-Da Hospital/I-Shou University, Kaohsiung, Taiwan
Search for more papers by this authorI-Te Lee
Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan
Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
Search for more papers by this authorToong-Hua Liang
Rheumatology Section, Renai Branch, Taipei City Hospital, Taipei, Taiwan
Search for more papers by this authorHsiao-Yi Lin
Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan
Division of Allergy, Immunology and Rheumatology, Department of Medicine, Cheng Hsin General Hospital, Taipei, Taiwan
Search for more papers by this authorShih-Chang Lin
Division of Rheumatology and Immunology, Cathay General Hospital, Taipei, Taiwan
Department of Medicine, College of Medicine, Fu-Jen Catholic University, New Taipei, Taiwan
Search for more papers by this authorWen-Pin Tsai
Department of Immunology and Rheumatology, Hsinchu MacKay Memorial Hospital, Hsinchu, Taiwan
Search for more papers by this authorGregory J. Tsay
Division of Immunology and Rheumatology, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
Search for more papers by this authorJames Cheng-Chung Wei
Division of Allergy, Immunology and Rheumatology, Chung Shan Medical University Hospital, Taichung, Taiwan
Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
Graduate Institute of Integrated Medicine, China Medical University, Taichung, Taiwan
Search for more papers by this authorChung-Han Yang
Division of Rheumatology, Allergy, and Immunology, Chang Gung Memorial Hospital, Chang Gung University, Taipei, Taiwan
Department of Internal Medicine, Landseed Hospital, Taoyuan, Taiwan
Search for more papers by this authorCorresponding Author
Wen-Chan Tsai
Department of Allergy, Immunology, and Rheumatology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
Correspondence: Professor Wen-Chan Tsai, Department of Allergy, Immunology, and Rheumatology, Kaohsiung Medical University Hospital, 100 Tzyou 1st Road, Kaohsiung 807, Taiwan.
Email: [email protected]
Search for more papers by this authorKuang-Hui Yu
Division of Rheumatology, Allergy, and Immunology, Chang Gung Memorial Hospital, Chang Gung University, Taipei, Taiwan
Authors are listed in alphabetical order, except for the first and last author.Search for more papers by this authorDer-Yuan Chen
Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan
Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
Ph.D. Program in Translational Medicine, Rong Hsing Research Center for Translational Medicine, National Chung Hsing University, Taichung, Taiwan
Search for more papers by this authorJiunn-Horng Chen
Division of Immunology and Rheumatology, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
Search for more papers by this authorShih-Yang Chen
Center of Gout, Country Hospital, Taipei, Taiwan
Search for more papers by this authorShyh-Ming Chen
Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University, Kaohsiung, Taiwan
Search for more papers by this authorTien-Tsai Cheng
Division of Rheumatology, Allergy and Immunology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University, Kaohsiung, Taiwan
Search for more papers by this authorSong-Chou Hsieh
Division of Rheumatology, Immunology and Allergy, Department of Internal Medicine, National Taiwan University Hospital, Hsinchu, Taiwan
Search for more papers by this authorTsu-Yi Hsieh
Division of Allergy, Immunology, and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
Ph.D. Program of Business, Institute of Business, Feng-Chia University, Taichung, Taiwan
Search for more papers by this authorPai-Feng Hsu
Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan
Department of Healthcare and Services Center, Taipei Veterans General Hospital, Taipei, Taiwan
Search for more papers by this authorChang-Fu Kuo
Division of Rheumatology, Allergy, and Immunology, Chang Gung Memorial Hospital, Chang Gung University, Taipei, Taiwan
Search for more papers by this authorMei-Chuan Kuo
Division of Nephrology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
Faculty of Renal Care, Kaohsiung Medical University, Kaohsiung, Taiwan
Search for more papers by this authorHing-Chung Lam
Division of Endocrinology and Metabolism, Department of Internal Medicine, E-Da Hospital/I-Shou University, Kaohsiung, Taiwan
Search for more papers by this authorI-Te Lee
Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan
Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
Search for more papers by this authorToong-Hua Liang
Rheumatology Section, Renai Branch, Taipei City Hospital, Taipei, Taiwan
Search for more papers by this authorHsiao-Yi Lin
Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan
Division of Allergy, Immunology and Rheumatology, Department of Medicine, Cheng Hsin General Hospital, Taipei, Taiwan
Search for more papers by this authorShih-Chang Lin
Division of Rheumatology and Immunology, Cathay General Hospital, Taipei, Taiwan
Department of Medicine, College of Medicine, Fu-Jen Catholic University, New Taipei, Taiwan
Search for more papers by this authorWen-Pin Tsai
Department of Immunology and Rheumatology, Hsinchu MacKay Memorial Hospital, Hsinchu, Taiwan
Search for more papers by this authorGregory J. Tsay
Division of Immunology and Rheumatology, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
Search for more papers by this authorJames Cheng-Chung Wei
Division of Allergy, Immunology and Rheumatology, Chung Shan Medical University Hospital, Taichung, Taiwan
Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
Graduate Institute of Integrated Medicine, China Medical University, Taichung, Taiwan
Search for more papers by this authorChung-Han Yang
Division of Rheumatology, Allergy, and Immunology, Chang Gung Memorial Hospital, Chang Gung University, Taipei, Taiwan
Department of Internal Medicine, Landseed Hospital, Taoyuan, Taiwan
Search for more papers by this authorCorresponding Author
Wen-Chan Tsai
Department of Allergy, Immunology, and Rheumatology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
Correspondence: Professor Wen-Chan Tsai, Department of Allergy, Immunology, and Rheumatology, Kaohsiung Medical University Hospital, 100 Tzyou 1st Road, Kaohsiung 807, Taiwan.
Email: [email protected]
Search for more papers by this authorAbstract
Gout is an inflammatory disease manifested by the deposition of monosodium urate (MSU) crystals in joints, cartilage, synovial bursa, tendons or soft tissues. Gout is not a new disease, which was first documented nearly 5,000 years ago. The prevalence of gout has increased globally in recent years, imposing great disease burden worldwide. Moreover, gout or hyperuricemia is clearly associated with a variety of comorbidities, including cardiovascular diseases, chronic kidney disease, urolithiasis, metabolic syndrome, diabetes mellitus, thyroid dysfunction, and psoriasis. To prevent acute arthritis attacks and complications, earlier use of pharmacotherapeutic treatment should be considered, and patients with hyperuricemia and previous episodes of acute gouty arthritis should receive long-term urate-lowering treatment. Urate-lowering drugs should be used during the inter-critical and chronic stages to prevent recurrent gout attacks, which may elicit gradual resolution of tophi. The goal of urate-lowering therapy should aim to maintain serum uric acid (sUA) level <6.0 mg/dL. For patients with tophi, the initial goal can be set at lowering sUA to <5.0 mg/dL to promote tophi dissolution. The goal of this consensus paper was to improve gout and hyperuricemia management at a more comprehensive level. The content of this consensus paper was developed based on local epidemiology and current clinical practice, as well as consensuses from two multidisciplinary meetings and recommendations from Taiwan Guideline for the Management of Gout and Hyperuricemia.
References
- 1Kuo CF, Grainge MJ, Zhang W et al. (2015) Global epidemiology of gout: prevalence, incidence and risk factors. Nat Rev Rheumatol 11, 649–62.
- 2Kuo CF, Grainge MJ, See LC et al. (2015) Epidemiology and management of gout in Taiwan: a nationwide population study. Arthritis Res Ther 17, 13.
- 3Chuang SY, Lee SC, Hsieh YT, Pan WH (2011) Trends in hyperuricemia and gout prevalence: Nutrition and Health Survey in Taiwan from 1993–1996 to 2005–2008. Asia Pac J Clin Nutr 20, 301–8.
- 4Kuo CF, Grainge MJ, See LC et al. (2015) Familial aggregation of gout and relative genetic and environmental contributions: a nationwide population study in Taiwan. Ann Rheum Dis 74, 369–74.
- 5Howick J, Chalmers I, Glasziou P et al. (2011) OCEBM Levels of Evidence Working Group. “The Oxford 2011 Levels of Evidence”. Oxford Centre for Evidence-Based Medicine. http://www.cebm.net/index.aspx?o=5653
- 6Campion EW, Glynn RJ, DeLabry LO (1987) Asymptomatic hyperuricemia. Risks and consequences in the Normative Aging Study. Am J Med 82, 421–6.
- 7Annemans L, Spaepen E, Gaskin M et al. (2008) Gout in the UK and Germany: prevalence, comorbidities and management in general practice 2000–2005. Ann Rheum Dis 67, 960–6.
- 8Bieber JD, Terkeltaub RA (2004) Gout: on the brink of novel therapeutic options for an ancient disease. Arthritis Rheum 50, 2400–14.
- 9Roubenoff R (1990) Gout and hyperuricemia. Rheum Dis Clin North Am 16, 539–50.
- 10Tian Y, Chen K, Xie Z et al. (2015) The association between serum uric acid levels, metabolic syndrome and cardiovascular disease in middle aged and elderly Chinese: results from the DYSlipidemia International Study. BMC Cardiovasc Disord 15, 66.
- 11Chao TF, Liu CJ, Chen SJ et al. (2014) Hyperuricemia and the risk of ischemic stroke in patients with atrial fibrillation–could it refine clinical risk stratification in AF? Int J Cardiol 170, 344–9.
- 12Abbott RD, Brand FN, Kannel WB et al. (1988) Gout and coronary heart disease: the Framingham Study. J Clin Epidemiol 41, 237–42.
- 13Choi HK, Curhan G (2007) Independent impact of gout on mortality and risk for coronary heart disease. Circulation 116, 894–900.
- 14Huang CC, Huang PH, Chen JH et al. (2015) An independent risk of gout on the development of deep vein thrombosis and pulmonary embolism: a nationwide, population-based cohort study. Medicine (Baltimore) 94, e2140.
- 15Chen YF, Lin HH, Lu CC et al. (2015) Gout and a subsequent increased risk of erectile dysfunction in men aged 64 and under: a nationwide cohort study in Taiwan. J Rheumatol 42, 1898–905.
- 16Roughley MJ, Belcher J, Mallen CD et al. (2015) Gout and risk of chronic kidney disease and nephrolithiasis: meta-analysis of observational studies. Arthritis Res Ther 17, 90.
- 17Liu P, Chen Y, Wang B et al. (2015) Allopurinol treatment improves renal function in patients with type 2 diabetes and asymptomatic hyperuricemia: 3-year randomized parallel-controlled study. Clin Endocrinol (Oxf) 83, 475–82.
- 18Sircar D, Chatterjee S, Waikhom R et al. (2015) Efficacy of febuxostat for slowing the GFR decline in patients with CKD and asymptomatic hyperuricemia: a 6-month, double-blind, randomized, placebo-controlled trial. Am J Kidney Dis 66, 945–50.
- 19Prasad Sah OS, Qing YX (2015) Associations between hyperuricemia and chronic kidney disease: a review. Nephrourol Mon 7, e27233.
- 20Juraschek SP, Kovell LC, Miller ER III et al. (2013) Association of kidney disease with prevalent gout in the United States in 1988–1994 and 2007–2010. Semin Arthritis Rheum 42, 551–61.
- 21Liu WC, Hung CC, Chen SC et al. (2012) Association of hyperuricemia with renal outcomes, cardiovascular disease, and mortality. Clin J Am Soc Nephrol 7, 541–8.
- 22Chen JH, Pan WH, Hsu CC et al. (2013) Impact of obesity and hypertriglyceridemia on gout development with or without hyperuricemia: a prospective study. Arthritis Care Res (Hoboken) 65, 133–40.
- 23Wei CY, Sun CC, Wei JC et al. (2015) Association between hyperuricemia and metabolic syndrome: an epidemiological study of a labor force population in Taiwan. Biomed Res Int 2015, 369179.
- 24Kushiyama A, Tanaka K, Hara S et al. (2014) Linking uric acid metabolism to diabetic complications. World J Diabetes 5, 787–95.
- 25See LC, Kuo CF, Yu KH et al. (2014) Hyperthyroid and hypothyroid status was strongly associated with gout and weakly associated with hyperuricaemia. PLoS ONE 9, e114579.
- 26Lai YC, Yew YW (2016) Psoriasis and uric acid: a population-based cross-sectional study. Clin Exp Dermatol 41, 260–6.
- 27Burns CM, Wortmann RL (2012). Disorders of purine and pyramidine metabolism. In: FADL Longo, DL Kasper, SL Hauser, JL Jameson, J Loscalzo (eds) Harrison's Principles of Internal Medicine. McGraw-Hill, New York.
- 28Khanna D, Fitzgerald JD, Khanna PP et al. (2012) 2012 American College of Rheumatology Guidelines for Management of Gout Part I: systematic nonpharmacologic and pharmacologic therapeutic approaches to hyperuricemia. Arthritis Care Res 64, 1431–46.
- 29Vitart V, Rudan I, Hayward C et al. (2008) SLC2A9 is a newly identified urate transporter influencing serum urate concentration, urate excretion and gout. Nat Genet 40, 437–42.
- 30Choi HK, Atkinson K, Karlson EW et al. (2005) Obesity, weight change, hypertension, diuretic use, and risk of gout in men: the health professionals follow-up study. Arch Intern Med 165, 742–8.
- 31Lin KC, Lin HY, Chou P (2000) The interaction between uric acid level and other risk factors on the development of gout among asymptomatic hyperuricemic men in a prospective study. J Rheumatol 27, 1501–5.
- 32Lin HY, Rocher LL, McQuillan MA et al. (1989) Cyclosporine-induced hyperuricemia and gout. N Engl J Med 321, 287–92.
- 33Yu TF (1984) Diversity of clinical features in gouty arthritis. Semin Arthritis Rheum 13, 360–8.
- 34Yu KH, Wu YJJ (2006) Gout and hyperuricemia: recent advances and a systematic review. Formosan J Rheumatol 20, 6–18.
- 35Yu KH, Luo SF (2003) Younger age of onset of gout In Taiwan. Rheumatology 42, 166–70.
- 36Yu KH, Ho HH, Chen JY et al. (2004) Gout complicated with necrotizing fasciitis–report of 15 cases. Rheumatology (Oxford) 43, 518–21.
- 37Yu KH, Luo SF, Liou LB et al. (2003) Concomitant septic and gouty arthritis–an analysis of 30 cases. Rheumatology (Oxford) 42, 1062–6.
- 38Neogi T, Jansen TL, Dalbeth N et al. (2015) 2015 Gout Classification Criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative. Arthritis Rheumatol 67, 2557–68.
- 39Chen DY, Lee IT, Lin SC et al. (2016) Taiwan guideline for the management of gout and hyperuricemia – updated 2106. Formosan J Rheumatol 30, 1–32.
- 40Hui M, Carr A, Cameron S et al. (2017) The British Society for Rheumatology Guideline for the Management of Gout. Rheumatology 56, e1–20.
- 41Yamanaka H, Japanese Society of Gout and Nucleic Acid Metabolism (2011) Japanese guideline for the management of hyperuricemia and gout. Nucleosides Nucleotides Nucleic Acids 30, 1018–29.
- 42Zhang W, Doherty M, Bardin T et al. (2006) EULAR evidence based recommendations for gout. Part II: management. Report of a task force of the EULAR Standing Committee for International Clinical Studies Including Therapeutics (ESCISIT). Ann Rheum Dis 65, 1312–24.
- 43Graf SW, Whittle SL, Wechalekar MD et al. (2015) Australian and New Zealand recommendations for the diagnosis and management of gout: integrating systematic literature review and expert opinion in the 3e Initiative. Int J Rheum Dis 18, 341–51.
- 44Khanna PP, Gladue HS, Singh MK et al. (2014) Treatment of acute gout: a systematic review. Semin Arthritis Rheum 44, 31–8.
- 45Schlesinger N, Detry MA, Holland BK et al. (2002) Local ice therapy during bouts of acute gouty arthritis. J Rheumatol 29, 331–4.
- 46Becker MA, Jolly M (2005). Clinical gout and the pathogenesis of hyperuricemia. In: WJ Koopman (ed) Arthritis and Allied Conditions, 15th edn, pp 2303–39. Williams & Wilkins, Baltimore.
- 47Chen SY, Chen CL, Shen ML et al. (2003) Trends in the manifestations of gout in Taiwan. Rheumatology (Oxford) 42, 1529–33.
- 48Ferraz MB, O'Brien B (1995) A cost effectiveness analysis of urate lowering drugs in nontophaceous recurrent gouty arthritis. J Rheumatol 22, 908–14.
- 49Wortmann RL, Kelley WN (2005). Gout and hyperuricemia. In: WN Kelley, S Ruddy, CB Sledge (eds) Kelley‘s Textbook of Rheumatology, pp 1402–48. W.B. Saunders, Philadelphia.
- 50Falidas E, Rallis E, Bournia VK et al. (2011) Multiarticular chronic tophaceous gout with severe and multiple ulcerations: a case report. J Med Case Rep 5, 397.
- 51Mittag F, Wuenschel M (2011) Giant gouty tophi of the hand and wrist. Orthopedics 34, e790–2.
- 52Becker MA, Schumacher HR Jr, Wortmann RL et al. (2005) Febuxostat compared with allopurinol in patients with hyperuricemia and gout. N Engl J Med 353, 2450–61.
- 53Yang CY, Chen CH, Deng ST et al. (2015) Allopurinol use and risk of fatal hypersensitivity reactions: a nationwide population-based study in Taiwan. JAMA Intern Med 175, 1550–7.
- 54Ko TM, Tsai CY, Chen SY et al. (2015) Use of HLA-B*58:01 genotyping to prevent allopurinol induced severe cutaneous adverse reactions in Taiwan: national prospective cohort study. BMJ 351, h4848.
- 55Goldfarb DS, MacDonald PA, Hunt B et al. (2011) Febuxostat in gout: serum urate response in uric acid overproducers and underexcretors. J Rheumatol 38, 1385–9.
- 56Smolen LJ, Gahn JC, Mitri G et al. (2016) Febuxostat in the management of gout: a cost-effectiveness analysis. J Med Econ 19, 265–76.
- 57Arai M, Yokosuka O, Fujiwara K et al. (2002) Fulminant hepatic failure associated with benzbromarone treatment: a case report. J Gastroenterol Hepatol 17, 625–6.
- 58Burns CM, Wortmann RL (2012) Latest evidence on gout management: what the clinician needs to know. Ther Adv Chronic Dis 3, 271–86.
- 59Ho WT (1986) Analysis of purines and pyrimidines contents of foods commonly consumed in Taiwan. J Chinese Nutrit Soc 11, 41–62.
- 60Torralba KD, De Jesus E, Rachabattula S (2012) The interplay between diet, urate transporters and the risk for gout and hyperuricemia: current and future directions. Int J Rheum Dis 15, 499–506.
- 61Chen JH, Wen CP, Wu SB et al. (2015) Attenuating the mortality risk of high serum uric acid: the role of physical activity underused. Ann Rheum Dis 74, 2034–42.
- 62Choi HK, Curhan G (2005) Adiposity, hypertension, diuretic use and risk of incident gout in women: The Nurses Health Study. Arthritis Rheum 52 (Suppl. 9), S733.
- 63Feinstein EI, Quion-Verde H, Kaptein EM et al. (1984) Severe hyperuricemia in patients with volume depletion. Am J Nephrol 4, 77–80.
- 64Schlesinger N (2005) Dietary factors and hyperuricaemia. Curr Pharm Des 11, 4133–8.
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