Sun Mingshu, Lyu Zhaohui, Wang Can, Li Yan, Zhao Dongbao, Ran Xingwu, Chen Haibing, Su Benli, Chang Xiangyun, Liu Ping, Yan Dewen, Jiang Xiuyun, Chen Kang, Shao Jiaqing, Teng Xiaochun, Yao Yongli, Li Yuming, Chen Ying, Cheng Jidong, Cheng Zhifeng, Liu Zhen, Liu Fengjing, Li Xinyu, Yin Huiyong, Liu Chao, Lin Hsiao-Yi, Chen Yaolong, Tsai Wen-Chan, Yip Ronald M L, Li Changgui, Zhao Jiajun
Department of Rheumatology, Xiang'an Hospital of Xiamen University, Xiamen, China.
Department of Endocrinology, the First Medical Center of Chinese PLA General Hospital, Beijing, China.
Int J Rheum Dis. 2025 Jul;28(7):e70375. doi: 10.1111/1756-185x.70375.
In 2018, the Chinese Society of Endocrinology developed the "Chinese guideline for diagnosis and treatment of hyperuricemia and gout (2019)". Over the past 5 years, clinical and experimental research has expanded our knowledge of gout, resulting in novel diagnostic and therapeutic approaches. This update, prompted by new clinical challenges and gaps in evidence, aims to refine the 2019 guidelines.
The working group formulated clinical questions based on a nationwide questionnaire survey, and the expert panel evaluated new evidence addressing these questions from January 2019 to March 2025. The guideline development followed the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach, adhering to internationally recognized protocols for clinical practice guideline development.
The update includes 26 recommendations addressing 10 clinical questions related to urate-lowering therapy (ULT) for asymptomatic hyperuricemia and reproductive populations, anti-inflammatory treatments, urine alkalinization, dietary advice, and gout diagnosis in patients without a record of hyperuricemia and gout flare predictions in patients with asymptomatic hyperuricemia and intermittent gout. It recommends febuxostat as a first-line ULT for asymptomatic hyperuricemia and using it with caution during pregnancy and lactation. ULT should be customized according to the pathophysiologic type of hyperuricemia. Chronic gout management includes maintaining serum urate levels between 180 and 300 μmol/L and prolonged glucocorticoid tapering in combination with colchicine. Alkalinization with citrate is preferred over sodium bicarbonate for patients with urine pH < 6.0. Novel biomarkers for predicting gout flares are proposed for high-risk populations.
These updated guidelines incorporate expert consensus and evidence to provide refined strategies for the diagnosis, prevention, and treatment of hyperuricemia and gout.
2018年，中华医学会内分泌学分会制定了《中国高尿酸血症与痛风诊疗指南（2019年版）》。在过去5年中，临床和实验研究拓展了我们对痛风的认识，产生了新的诊断和治疗方法。本次更新由新的临床挑战和证据空白引发，旨在完善2019年版指南。
工作组基于全国性问卷调查制定临床问题，专家小组评估了2019年1月至2025年3月期间针对这些问题的新证据。指南制定遵循推荐分级的评估、制定和评价（GRADE）方法，遵循国际认可的临床实践指南制定方案。
本次更新包括26条推荐意见，涉及10个临床问题，涵盖无症状高尿酸血症和生殖人群的降尿酸治疗（ULT）、抗炎治疗、尿液碱化、饮食建议，以及无高尿酸血症病史患者的痛风诊断和无症状高尿酸血症及间歇性痛风患者的痛风发作预测。推荐非布司他作为无症状高尿酸血症的一线ULT，并在妊娠和哺乳期谨慎使用。ULT应根据高尿酸血症的病理生理类型进行个体化定制。慢性痛风管理包括将血清尿酸水平维持在180至300μmol/L之间，并联合秋水仙碱延长糖皮质激素的减量过程。对于尿pH<6.0的患者，枸橼酸盐碱化优于碳酸氢钠。为高危人群提出了预测痛风发作的新型生物标志物。
这些更新后的指南纳入了专家共识和证据，为高尿酸血症和痛风的诊断、预防和治疗提供了优化策略。
