Zhang Xuexue, Tang Yuting, Wang Miaoran, Wang Dongsheng, Li Qiuyan
Department of endocrinology, China Academy of Chinese Medical Sciences, Beijing, China.
Department of Integrative Chinese and Western Medicine, Central South University, Changsa, Hunan, China.
Clin Rheumatol. 2021 Feb;40(2):701-710. doi: 10.1007/s10067-020-05215-z. Epub 2020 Jun 19.
Gout is a common chronic disease with a high recurrence rate. To date, the debate continues about the best time for using urate lowering therapy (ULT) during an acute gout attack.
This updated meta-analysis is designed to assess the clinical efficacy of ULT in the management of acute exacerbations of gout. Through the results, we hope to determine whether uric acid lowering agents should be used to manage acute exacerbations of gout.
A comprehensive search of six databases without language restrictions includes PubMed, Cochrane Library, Web of Science, EMBASE, CNKI, and WanFang data. The literature used was published before October 2019. Six randomized controlled trials (RCTs) with 557 patients met the inclusion criteria. Standardized mean difference (SMD), weighted mean difference (WMD), risk ratio (RR), and 95% confidence interval (CI) were used for estimating the clinical efficacy of ULT in acute gout.
Data results showed no statistical difference in the pain visual analogue score (VAS) by day 3 (weighted mean difference (WMD), 0.06; 95% CI, - 0.13 to 0.25; I 0%; P = 0.55), erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) between the group using uric acid lowering agents and the group that was not using such agents. Moreover, the patients using ULT agents had lower serum uric acid level (standardized mean difference (SMD), - 0.73; 95% CI, -0.92 to -0.54; I 23%; P < 0.00001) and showed better adherence to medication (risk ratio (RR), 1.40; 95% CI, 1.18 to 1.65; I 0%; P < 0.0001) as compared with the patients not that were not using such agents. However, there was no substantial difference in the recurrence rate of acute gout attacks (RR, 0.84; 95% CI, 0.59 to 1.19; I 0%; P = 0.33).The evidence for this is, however, very moderate.
Our finding shows that it is beneficial in many aspects to use uric-acid-lowering drugs at the initial stage of an acute gout attack. However, larger sample size studies are still needed to prove our results.
Registration number: PROSPERO (CRD42020153924). Key Points • This is a first meta-analysis about the clinical efficacy of urate-lowering therapy (ULT) in acute gout without language restrictions. • ULT in acute gout may not aggravate the pain (WMD, 0.06; 95% CI, - 0.13 to 0.25). • ULT at the initial stage of an acute gout attack can reduce serum uric acid level (SMD, -0.73; 95% CI, - 0.92 to - 0.54) and improve medication compliance in patients (RR, 1.40; 95% CI, 1.18 to 1.65). • ULT in acute gout is not associated with the risk of gout flares (RR, 0.84; 95% CI, 0.59 to 1.19).
痛风是一种常见的慢性病，复发率高。迄今为止，关于在急性痛风发作期间使用降尿酸治疗（ULT）的最佳时机的争论仍在继续。
本更新的荟萃分析旨在评估ULT在痛风急性发作管理中的临床疗效。通过结果，我们希望确定是否应使用降尿酸药物来管理痛风急性发作。
全面检索六个无语言限制的数据库，包括PubMed、Cochrane图书馆、科学网、EMBASE、中国知网和万方数据。所使用的文献发表于2019年10月之前。六项随机对照试验（RCT）共557例患者符合纳入标准。采用标准化均数差（SMD）、加权均数差（WMD）、风险比（RR）和95%置信区间（CI）来评估ULT在急性痛风中的临床疗效。
数据结果显示，在第3天时，使用降尿酸药物组与未使用降尿酸药物组在疼痛视觉模拟评分（VAS）（加权均数差（WMD），0.06；95%CI，-0.13至0.25；I² 0%；P = 0.55）、红细胞沉降率（ESR）和C反应蛋白（CRP）方面无统计学差异。此外，与未使用ULT药物的患者相比，使用ULT药物的患者血清尿酸水平更低（标准化均数差（SMD），-0.73；95%CI，-0.92至-0.54；I² 23%；P < 0.00001），并且在药物依从性方面表现更好（风险比（RR），1.40；95%CI，1.18至1.65；I² 0%；P < 0.0001）。然而，急性痛风发作的复发率没有实质性差异（RR，0.84；95%CI，0.59至1.19；I² 0%；P = 0.33）。不过，这方面的证据非常有限。
我们的研究结果表明，在急性痛风发作初期使用降尿酸药物在许多方面是有益的。然而，仍需要更大样本量的研究来证实我们的结果。
注册号：PROSPERO（CRD42020153924）。要点 • 这是第一项关于降尿酸治疗（ULT）在急性痛风中临床疗效的无语言限制的荟萃分析。 • 急性痛风中的ULT可能不会加重疼痛（WMD，0.06；95%CI，-0.13至0.25）。 • 急性痛风发作初期的ULT可降低血清尿酸水平（SMD，-0.73；95%CI，-0.92至-0.54）并提高患者的药物依从性（RR，1.40；95%CI，1.18至1.65）。 • 急性痛风中的ULT与痛风发作风险无关（RR，0.84；95%CI，0.59至1.19）。
