Institute of Genetics and Molecular Medicine, University of Edinburgh.
Curr Opin Rheumatol. 2014 Mar;26(2):152-61. doi: 10.1097/BOR.0000000000000034.
Appraisal of the 2012 American College of Rheumatology (ACR) Guidelines for the Management of Gout.
The ACRs first clinical practice guidelines for the management of gout focus on recommendations for nonpharmacologic and pharmacologic approaches to hyperuricaemia and the treatment and prophylaxis of acute gouty arthritis. The RAND/UCLA appropriateness methodology employed assessed risks and benefits of alternative treatments for efficacy, safety and quality but not for cost-effectiveness. Novel recommendations include the use of either allopurinol or febuxostat for first-line urate-lowering drug therapy (ULT), screening for HLA-B*5801 prior to initiation of allopurinol in Asians at relatively high risk for allopurinol hypersensitivity, and the use of pegloticase for patients with severe, symptomatic, tophaceous gout refractory to, or intolerant of, appropriately dosed ULTs. Appraisal and comparison with other guidelines using Guidelines International Network and Appraisal of Guidelines, Research and Evaluation (AGREE II) criteria showed good scores for scope and purpose, stakeholder involvement, rigour of development, clarity of presentation, editorial independence and, overall quality, but not for applicability.
The ACR guidelines provide comprehensive, up-to-date, good-quality, evidence-based, expert consensus recommendations for the management of gout in clinical practice but score poorly for applicability. To improve the management of gout in the community a summary of key recommendations, criteria for audit and standards of care are now required.
评估 2012 年美国风湿病学会（ACR）痛风管理指南。
ACR 第一部痛风管理临床实践指南侧重于高尿酸血症的非药物和药物治疗方法以及急性痛风性关节炎的治疗和预防的建议。采用 RAND/UCLA 适宜性方法评估替代治疗方法的疗效、安全性和质量方面的风险和益处，但不评估成本效益。新的建议包括在亚洲人群中使用别嘌醇或非布司他作为一线降尿酸药物治疗（ULT），在有较高别嘌醇过敏风险的亚洲人群中使用别嘌醇前进行 HLA-B*5801 筛查，以及在对适当剂量 ULT 不耐受或无效的严重、有症状、有痛风石的患者中使用培戈洛酶。使用指南国际网络（Guidelines International Network）和评估、制定、研究与评价（Appraisal of Guidelines, Research and Evaluation，AGREE II）标准对该指南进行评估和与其他指南进行比较，发现其在范围和目的、利益相关者参与、制定严谨性、表述清晰度、编辑独立性和整体质量方面得分良好，但在适用性方面得分较低。
ACR 指南为痛风的临床管理提供了全面、最新、高质量、基于证据的专家共识建议，但在适用性方面得分较低。为了改善社区中痛风的管理，现在需要总结关键建议、审核标准和护理标准。
