The effect of initiation of urate-lowering treatment during a gout flare on the current episode: a meta-analysis of randomized controlled trials

Ertao Jia,Jingjing Xie,Hongling Geng,Jiaxin Wei,Yubao Jiang,Xia Qiu,Min Xiao,Yanying Zhang,Xiaoling Yao,Jianyong Zhang,Dabin Tang,Li Zhong,Yuya Xiao

doi:10.1186/s42358-022-00236-5

Abstract

ObjectiveThe objective was to evaluate whether initiation of urate-lowering treatment (ULT) during an acute gout flare prolonged the current episode.MethodsA comprehensive search of MEDLINE and Web of Science databases was conducted from their inception to 15 March 2021. Five randomized controlled trials (RCTs) with 381 patients met the inclusion criteria. Standardized mean difference (SMD), odds ratio (OR), and 95% confidence interval (CI) were used for estimating the clinical efficacy of ULT in acute gout.ResultsThere was no statistical difference in days to resolution (intent-to-treat analysis) (SMD, 0.68; 95% CI − 0.42 to 1.78; I2, 49%; p = 0.22), the pain visual analogue score (VAS) by day 10 (SMD, − 0.07; 95% CI − 0.30 to 0.16; I2, 0%; p = 0.53), C-reactive protein (CRP) from day 7 to 10 (SMD, − 1.14; 95% CI − 5.63 to 3.36; I2, 55%; p = 0.62), erythrocyte sedimentation rate (ESR) from day 7 to 10 (SMD, − 2.51; 95% CI − 5.46 to 0.45; I2, 0%; p = 0.10) and the recurrence of gout flares within 28–30 days (OR 0.78; 95% CI 0.29 to 2.09; I2, 0%; p = 0.62).ConclusionInitiation of ULT during an acute gout flare did not prolong the duration of the flare. However, larger sample size studies are needed to confirm this finding.Trial registration number PROSPERO (CRD42021234581).

Highlights

Gout is a common arthritic condition that results from monosodium urate (MSU) crystal deposition
There was no statistical difference in days to resolution (SMD, 0.68; 95% confidence interval (CI) − 0.42 to 1.78; I2, 49%; p = 0.22), the pain visual analogue score (VAS) by day 10 (SMD, − 0.07; 95% CI − 0.30 to 0.16; I2, 0%; p = 0.53), C-reactive protein (CRP) from day 7 to 10 (SMD, − 1.14; 95% CI − 5.63 to 3.36; I2, 55%; p = 0.62), erythrocyte sedimentation rate (ESR) from day 7 to 10 (SMD, − 2.51; 95% CI − 5.46 to 0.45; I2, 0%; p = 0.10) and the recurrence of gout flares within 28–30 days
The 2020 American College of Rheumatology (ACR) guidelines for the management of gout have conditionally recommended that pharmacological urate-lowering treatment (ULT) could be initiated during an acute gout flare [3]

Summary

Introduction

Gout is a common arthritic condition that results from monosodium urate (MSU) crystal deposition. ULT could be initiated during an acute flare to reduce the number of outpatient visits, and increase patient compliance [6,7,8]. The 2016 EULAR Gout Management Recommendations did not provide any clear. The 2020 American College of Rheumatology (ACR) guidelines for the management of gout have conditionally recommended that pharmacological ULT could be initiated during an acute gout flare [3]. The two RCTs observed that initiating allopurinol treatment during an acute gout flare did not prolong the days to resolution [11]. Two RCTs have been published on the initiation of febuxostat for acute gout flares [13, 14]

Methods

Results

Conclusion