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Diagnosis and treatment for hyperuricemia and gout: a systematic review of clinical practice guidelines and consensus
Qianrui Li1,2, Xiaodan Li3, Jing Wang4
1Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, China.
Insights
Guidance documents for gout and hyperuricemia management show quality gaps, particularly in applicability and independence. Improving development methods and evidence synthesis can reduce inconsistent recommendations for gout treatment.
Area of Science:
- Rheumatology
- Clinical Practice Guidelines
- Evidence-Based Medicine
Background:
- Gout and hyperuricemia management remains suboptimal despite numerous trials.
- Existing clinical practice guidelines and consensus statements require quality assessment.
Purpose of the Study:
- To assess the quality and consistency of guidance documents for gout and hyperuricemia.
- To identify areas for improvement in clinical recommendations.
Main Methods:
- Systematic review and quality assessment using the Appraisal of Guidelines for Research and Evaluation (AGREE) II methodology.
- Inclusion of international and national/regional guidelines and consensus statements published in English or Chinese.
- Independent screening, data extraction, and scoring by multiple reviewers.
Main Results:
- Twenty-four guidance documents (2003-2017) were evaluated.
- Documents performed well in scope and clarity but poorly in applicability and editorial independence.
- Recommendations were consistent on target serum uric acid levels and first-line therapies but inconsistent on ULT initiation timing and asymptomatic hyperuricemia treatment.
Conclusions:
- Methodological quality of gout and hyperuricemia guidance documents needs enhancement.
- Lack of evidence for certain clinical questions persists.
- Standardized guidance development and high-quality evidence synthesis are recommended to reduce inconsistencies.
Objectives:
Despite the publication of hundreds of trials on gout and hyperuricemia, management of these conditions remains suboptimal. We aimed to assess the quality and consistency of guidance documents for gout and hyperuricemia.
Design:
Systematic review and quality assessment using the appraisal of guidelines for research and evaluation (AGREE) II methodology.
Data Sources:
PubMed and EMBASE (27 October 2016), two Chinese academic databases, eight guideline databases, and Google and Google scholar (July 2017).
Eligibility Criteria:
We included the latest version of international and national/regional clinical practice guidelines and consensus statements for diagnosis and/or treatment of hyperuricemia and gout, published in English or Chinese.
Data Extraction And Synthesis:
Two reviewers independently screened searched items and extracted data. Four reviewers independently scored documents using AGREE II. Recommendations from all documents were tabulated and visualised in a coloured grid.
Results:
Twenty-four guidance documents (16 clinical practice guidelines and 8 consensus statements) published between 2003 and 2017 were included. Included documents performed well in the domains of scope and purpose (median 85.4%, range 66.7%-100.0%) and clarity of presentation (median 79.2%, range 48.6%-98.6%), but unsatisfactory in applicability (median 10.9%, range 0.0%-66.7%) and editorial independence (median 28.1%, range 0.0%-83.3%). The 2017 British Society of Rheumatology guideline received the highest scores. Recommendations were concordant on the target serum uric acid level for long-term control, on some indications for urate-lowering therapy (ULT), and on the first-line drugs for ULT and for acute attack. Substantially inconsistent recommendations were provided for many items, especially for the timing of initiation of ULT and for treatment for asymptomatic hyperuricemia.
Conclusions:
Methodological quality needs improvement in guidance documents on gout and hyperuricemia. Evidence for certain clinical questions is lacking, despite numerous trials in this field. Promoting standard guidance development methods and synthesising high-quality clinical evidence are potential approaches to reduce recommendation inconsistencies.
Prospero Registration Number:
CRD42016046104.
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