RT Journal Article
SR Electronic
T1 Interventions for Tophi in Gout: A Cochrane Systematic Literature Review
JF The Journal of Rheumatology
JO J Rheumatol
FD The Journal of Rheumatology
SP 63
OP 69
DO 10.3899/jrheum.140464
VO 92
A1 Melonie K. Sriranganathan
A1 Ophir Vinik
A1 Louise Falzon
A1 Claire Bombardier
A1 Desiree M. van der Heijde
A1 Christopher J. Edwards
YR 2014
UL http://www.jrheum.org/content/92/63.abstract
AB Objective. To systematically review the available literature on the management of tophi in gout. This article is based on the Cochrane Review Interventions for Tophi in Gout published in the Cochrane Database of Systematic Reviews. Methods. Medline, Embase, and The Cochrane Library were searched using a strategy developed with an experienced librarian. We also searched American College of Rheumatology and European League Against Rheumatism conference abstracts from 2010–2011. Included articles were reviewed in detail and a risk of bias (using the Cochrane tool) and quality assessment were performed. Results. In total, 3206 references were recovered. Of these, 72 articles were selected based on our inclusion criteria. This included 1 report of 2 randomized controlled trials, 2 nonrandomized studies, and 69 case series and reports. The study with 2 randomized controlled trials looked at pegloticase. This showed improvement in tophi with treatment. One observational prospective trial looked at allopurinol and benzbromarone individually and in combination. It noted that achieving lower serum urate levels was associated with a faster reduction of tophi. An open-label extension trial noted that longterm maintenance of serum uric acid < 6.0 mg/dl with febuxostat led to a reduction in tophi. The case series and reports looked at surgical, pharmacological, and other interventions, as well as combination therapies. All surgical interventions reported improvement in pain and/or function. No report had objective measures of outcome. Conclusion. Treatment with urate-lowering therapy such as allopurinol, benzbromarone, allopurinol + benzbromarone in combination, febuxostat, or pegloticase can lead to reduction in tophi. There is some evidence that achieving a lower serum urate level leads to a faster rate of tophi reduction.