Background/Purpose: The 3e (Evidence, Expertise, Exchange) Initiative is a multinational collaboration that aims to promote evidence-based medicine in rheumatology. The 2011-12 3e Initiative aimed to develop evidence-based recommendations for the diagnosis and management in patients with gout by integrating evidence and the expert opinion of a broad international panel of rheumatologists.

Methods: 474 rheumatologists from 14 countries participated. Using a formal voting process, a panel of 78 rheumatologists developed a list of 10 clinical questions, 9 regarding the diagnosis and management of gout, and 1 focused on the management of asymptomatic hyperuricaemia. Bibliographic fellows undertook a systematic literature review for each clinical question. A literature search was performed using MEDLINE, EMBASE, Cochrane CENTRAL, and abstracts from 2010-11 EULAR and ACR meetings. Relevant studies were retrieved for data extraction and synthesis, and assessment of risk of bias. Using this evidence, rheumatologists from each country developed a set of national recommendations. Finally, multinational recommendations were formulated and assessed for agreement among the participants and the potential impact on clinical practice.

Results: In total, 42,823 references were identified, from which 325 studies were included in the systematic reviews. Combining this evidence and clinical expertise, the initial questions led to a set of 10 recommendations. Oxford Levels of Evidence were applied to each recommendation. One recommendation related to the potential role of clinical and laboratory data for the diagnosis of gout in the absence of crystal identification. Two recommendations considered screening for, and the management of cardiovascular and renal co-morbidities. Six recommendations focused on different aspects of the management of gout, with one recommendation considering a suitable treatment target and how to monitor patients. The last recommendation regarded the management of asymptomatic hyperuricaemia in order to prevent gout and renal and cardiovascular outcomes. The level of agreement by participants with the recommendations ranged from 8.1 to 9.2 (mean 8.7) on a 1-10 point scale with 10 representing full agreement. 17% (range 7.5-31.5%) of rheumatologists reported that the final set of recommendations would change their practice, and 79% (range 60.8-88.7%) felt that these recommendations were in accordance with their current practice.

Conclusion: Ten recommendations on the diagnosis and management of gout were established. They are evidence-based and supported by a large panel of rheumatologists from 14 countries, thus enhancing their utility in clinical practice.

ACR Meeting Abstracts - https://acrabstracts.org/abstract/multinational-evidence-based-recommendations-for-diagnosis-and-management-of-gout-integrating-systematic-literature-research-and-expert-opinion-of-a-broad-panel-of-rheumatologists-in-the-3e-initiativ/