The 3e (Evidence, Expertise, and Exchange) Initiative in Rheumatology is a multinational collaborative task force aiming at developing recommendations for rheumatologists’ daily clinical practice. This program addresses practical questions that rheumatologists face every day, by combining both systematic literature reviews (SLR) and opinions from international experts.
Since 2006, the 3e Initiative has successively taken interest in the management of ankylosing spondylitis1, the use of methotrexate in rheumatoid arthritis2, the management of patients with undifferentiated peripheral inflammatory arthritis3, and the management of pain by pharmacotherapy in inflammatory arthritis4.
For its fifth project, the 3e Initiative investigated the diagnosis and management of an old, but apparently increasingly prevalent disease, namely gout. Today, it is the most common form of inflammatory arthritis in industrialized countries, affecting 1% to 2% of men in Western countries5. Although progress has been made in understanding its pathogenesis treatment, and several questions remain concerning how to implement best practice in clincial settings.
Participants in the 3e Initiative on Diagnosis and Management of Gout project included 474 clinical experts in rheumatology from 14 countries. Using a Delphi process, a panel of experts drawn from among participants selected 10 questions relevant for daily practice:
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Under which circumstances can a diagnosis of gout be made on clinical grounds, with or without laboratory tests or imaging; and when is identification of crystals necessary?6
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Should patients with hyperuricemia and/or the diagnosis of gout be screened routinely for comorbidities and cardiovascular risk factors?7
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What is the role of glucocorticoids, colchicine, nonsteroidal antiinflammatory drugs, anti-interleukin 1, and paracetamol in the management of acute gout?8
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Which lifestyle changes (such as diet, alcohol intake, weight loss, smoking and/or exercise) are efficacious in the treatment/prevention of gout?9
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What is the efficacy, cost-efficacy, and safety of urate-lowering therapy (allopurinol, as well as febuxostat, peg-uricase, benzbromarone, and probenecid) in the treatment of gout? Which sequence of urate-lowering therapy or combinations of therapies should be recommended?10
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When introducing urate-lowering therapy, what is the best treatment to prevent an acute attack and for how long should it be continued? What is the optimum time to start urate-lowering therapy after an acute attack of gout?11
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How do common comorbidities (such as metabolic syndrome, and cardiovascular, gastrointestinal, and renal disease) influence the choice of gout-specific drugs (such as colchicine, allopurinol, and other urate-lowering therapy) in acute gout flare, chronic gout, and as prophylaxis for acute flare?12
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What should the treatment target be and how should patients with gout be followed (i.e., using which measures; e.g., patient-reported outcomes, clinical and biochemical and/or imaging outcomes)?13
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How should tophi be managed?14
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Can we prevent gouty arthritis, renal disease, and cardiovascular events by lowering serum uric acid levels in patients with asymptomatic hyperuricemia? If yes, what should the target levels be?15
The experts then discussed and debated a series of SLR based on the above questions and, via a voting process, came to a set of 10 recommendations on the diagnosis and management of gout16.
The present supplement gathers the 10 SLR. Each review covers a different aspect of the disease and the series as a whole shows all the supporting evidence for the recommendations. Among the SLR, 4 are copublished with the Cochrane Collaboration8,9,10,14, among which one is based upon 4 Cochrane reviews8.
We would like to thank all our expert rheumatologists, the scientific committee members, and the fellows for their collaboration and their impressive work to achieve the high-level scientific content of this fifth 3e Initiative.
Acknowledgments
The authors acknowledge the work of all members of the 3e scientific committees and all participants in the national meetings.
Footnotes
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Derived from the 3e Gout program, which was sponsored by AbbVie Inc. Logistical and administrative support for the 3e Gout meetings was provided by Margaux Orange, Paris, France; this work was funded by AbbVie Inc. AbbVie employees were present during the 3e meetings, but did not influence the scientific discussions. AbbVie did not review the content or have influence on this manuscript.