Summary

In their study, the authors had conducted a systematic evaluation of clinical practice guidelines and consensus statements on gout and hyperuricemia. Twenty-four guidance documents (16 clinical practice guidelines and 8 consensus statements) published between 2003 and 2017 were included. The study found that Allopurinol had emerged as the first-line pharmacological option for Urate Lowering Therapy (ULT) when explicitly provided as an option. Similarly, Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) were universally endorsed by most documents as the primary pharmacological treatment for acute gout attacks, with colchicine also receiving support in this aspect.

However, the study also revealed disparities in recommendations, regarding the timing of urate lowering therapy initiation and the management of asymptomatic hyperuricemia. These inconsistencies show the need for standardization in guidance development methods. As an example, ethical and social differences are important reasons why the recommendations may have varied. In the study, the Asian articles that were included were more likely to recommend HLA-B*5801 gene screening before prescribing allopurinol. HLA-B*5801 gene screening was promoted because the risk of hypersensitivity reactions associated with allopurinol is significantly increased in individuals carrying that variant allele. In providing ethnicity-specific recommendations helps clarify sources of inconsistency and improves the precision of recommendations.