2019年改訂高尿酸血症・痛風の治療ガイドライン第３版【英語版】

<p>[Background] Accumulated evidences suggested that hyperuricemia may be risk for renal failures, cardiovascular disease and life-style related disease since the 2^nd edition of the guideline for the management of hyperuricemia and gout published in 2010, while hyperuricemia is a definitive risk of gout and urolithiasis. Besides, the novel non-purine xanthine oxidoreductase inhibitors have been developed recently. However, it remains unclear whether pharmacological treatment for asymptomatic hyperuricemia may be recommended to protect from gout arthritis and renal and cardiovascular disease. [Objects] Japanese guideline for the management of hyperuricemia and gout the 3^rd edition tend to be developed to prevent patients, from asymptomatic hyperuricemia and gout. [Methods] After setting the important clinical issues on hyperuricemia and gout, seven clinical questions accompanied by advantage and disadvantage outcomes have been selected. Using the systematic reviews on reports related to outcome of each clinical question, bias risk of each evidence has been estimated. Taken together with the estimation of body of evidence, patients’ opinions and medical economics, the recommendation for each clinical question has been determined. [Results] 1) NSAIDs, glucocorticoid and colchicine are equally recommended to be use for gout attack, 2) Lowering serum urate less than 6mg/dL is recommended to treat tophus, 3) Long term colchicine cover is recommended to treat gout patients after administration of urate lowering agents (ULAs) than short period colchicine cover, 4) ULAs are partially recommended to use for hyperuricemic patients with CKD in order to suppress the deterioration of renal function, 5) ULAs are not partially recommended to use for hyperuricemic patients with hypertension in order to improve the prognosis and suppress the cardiovascular events, 6) ULAs is not partially recommended to use for hyperuricemic patients with heart failure in order to improve the prognosis and to suppress the cardiovascular events, 7) Dietary education including restriction of alcohol abuse is recommended for management of hyperuricemia. The Japanese version was published on December in 2018. This guideline has been translated into English. [Conclusion] This guideline is expected to cover the decision making against the important clinical issues on hyperuricemia and gout.</p>