Evidence
This page contains a snapshot of featured content which highlights evidence addressing key clinical questions including areas of uncertainty. Please see the main topic reference list for details of all sources underpinning this topic.
BMJ Best Practice evidence tables
Evidence tables provide easily navigated layers of evidence in the context of specific clinical questions, using GRADE and a BMJ Best Practice Effectiveness rating. Follow the links at the bottom of the table, which go to the related evidence score in the main topic text, providing additional context for the clinical question. Find out more about our evidence tables.
This table is a summary of the analysis reported in a guideline (underpinned by a systematic review) that focuses on the above important clinical question.
Confidence in the evidence is very low or low where GRADE has been performed and there may be no difference in effectiveness between the intervention and comparison for key outcomes. However, this is uncertain and new evidence could change this in the future.
Population: People with gout
Intervention: ULT during a gout flare
Comparison: ULT after a gout flare has resolved
| Outcome | Effectiveness (BMJ rating)? | Confidence in evidence (GRADE)? |
|---|---|---|
Gout flares (follow up: 8 weeks, 12 weeks, and at mean 36 weeks; assessed with proportion of participants with at least one flare) | No statistically significant difference | Very Low |
Gout flares (follow up: mean 30 days; assessed with proportion with flare in any joint) | No statistically significant difference | Low |
Gout flares (follow up: mean 28 days; assessed with time from enrollment in study to resolution of acute gout attack [intention to treat]) | No statistically significant difference | Low |
Serum urate (follow up: mean 36 weeks; assessed with participants with serum urate <6mg/dL [approx >360 micromol/L]) | No statistically significant difference | Very Low |
Serum urate (follow up: mean 10 days; assessed with mean change in serum urate level, mg/dL) | Favors intervention | Moderate |
Tophi (follow up: mean 36 weeks; assessed with proportion with tophi at follow up) | No statistically significant difference | Very Low |
Pain (follow up: mean 10 days; assessed with visual analog scale or numerical rating score [range 0-10]) | No statistically significant difference | Low |
Serious adverse events: death; hypersensitivity reaction (follow up; mean 30 days; assessed with proportion with serious adverse event) | No statistically significant difference | Low |
Recommendations as stated in the source guideline When the decision is made that ULT is indicated while the patient is experiencing a gout flare, starting ULT during the gout flare over starting ULT after the gout flare has resolved is conditionally recommended. ᵇ
Note ᵃ The guideline team assessed three studies related to this question; two of the studies (both small randomized controlled trials) explicitly mention evaluating allopurinol, but we were not able to confirm which specific ULT drug(s) were evaluated in the third (an observational study). ᵇ The guideline team noted that since this is a conditional recommendation, there may be patient factors or preferences that support delaying ULT initiation until the flare has resolved.
This evidence table is related to the following section/s:
Cochrane Clinical Answers
Cochrane Clinical Answers (CCAs) provide a readable, digestible, clinically focused entry point to rigorous research from Cochrane systematic reviews. They are designed to be actionable and to inform decision making at the point of care and have been added to relevant sections of the main Best Practice text.
- For people with acute gout, how do non‐steroidal anti‐inflammatory drugs (NSAIDs) compare with cyclo‐oxygenase (COX)‐2 inhibitors (COXIBs)?
- In people with chronic gout, is there randomized controlled trial evidence to support the use of lifestyle interventions?
- Does febuxostat improve outcomes in people with chronic gout?
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