Tophus severity grading and surgical treatment: Chinese Medical Doctor Association Multidisciplinary Expert Consensus...

Area of Science:

• Rheumatology
• Orthopedic Surgery
• Surgical Innovation

Background:

• Tophi are a severe complication of advanced gout, affecting 12-35% of patients and causing significant bone/joint damage and chronic wounds.
• Current surgical timing, perioperative management, and treatment for gouty tophus lack standardization, posing clinical challenges.
• An expert consensus statement was developed to address these challenges and guide surgical intervention for gouty tophus.

Purpose of the Study:

• To establish standardized criteria for grading tophus erosion severity.
• To develop evidence-based recommendations for the surgical management of gouty tophus.
• To improve clinical practice and patient outcomes through expert consensus.

Main Methods:

• A multidisciplinary expert committee was formed to address key questions regarding tophus surgery.
• Literature searches across 11 databases were conducted, followed by quality assessments.
• Nominal group technique meetings and Delphi voting rounds were used to establish grading criteria and recommendations, achieving 85% consensus.

Main Results:

• Standardized grading criteria (grades 1-4) for tophus erosion damage were established.
• Fourteen recommendations for surgical treatment were formulated, covering severity grading, perioperative management, and surgical indications.
• Eight recommendations were strongly recommended, and six were conditional.

Conclusions:

• This consensus introduces the first standardized criteria for grading tophus severity via multidisciplinary collaboration.
• Evidence-based recommendations are provided for optimal surgical timing, perioperative management, and treatment strategies.
• These recommendations serve as a foundation for future research and global standardization in surgical gouty tophus management.