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
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).
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.