Results of the selection
A total of 765 records were identified through database searching. Four other records were identified via the guideline development organization websites and Google Scholar. Of these, 17 guidelines that met the criteria were analyzed (Fig. 1).
Characteristics of the included CPGs
Of the 17 CPGs, one was in Chinese and 16 were in English. Nine were developed by European countries (52.9%), of which four were developed by EULAR (23.5%); six originated from the United States (35.3%), of which three were developed by ACR (17.6%) and three (17.6%) by universities. The remaining two (11.8%) were developed by the Evidence, Expertise, and Exchange initiative. The features of each are summarized in Table 1.
Table 1
Characteristics of included CPGs
Serial number | Title | Published date | Developer | Nation | Published journal |
1 | 2018 updated European League Against Rheumatism evidence-based recommendations for the diagnosis of gout[18] | 2019 | European League Against Rheumatism. | Europe | Annals of the Rheumatic Diseases |
2 | Management of gout and hyperuricemia: Multidisciplinary consensus in Taiwan[19] | 2018 | Astellas, Taiwan | Taiwan,China | SPECIAL EDITORIAL REVIEW |
3 | The British Society for Rheumatology Guideline for the Management of Gout[20] | 2017 | British Society for Rheumatology Standards, Audit and Guidelines Working Group. | UK | RHEUMATOLOGY |
4 | 1.Diagnosis of Acute Gout: A Clinical Practice Guideline From the American College of Physicians[21] 2.Management of Acute and Recurrent Gout: A Clinical Practice Guideline From the American College of Physicians[22] | 2017 | American College of Physicians | USA | Annals of Internal Medicine |
5 | [2016 China Gout Clinical Practice Guideline][23] | 2016 | Chinese Rheumatology Association | China | Zhonghua Nei Ke Za Zhi |
6 | 2016 updated EULAR evidence-based recommendations for the management of gout[24] | 2016 | European League Against Rheumatism | Europe | Clinical and epidemiological research |
7 | Treat-to-target (T2T) recommendations for gout[25] | 2016 | European League Against Rheumatism | Europe | Annals of the Rheumatic Diseases |
8 | Australian and New Zealand recommendations for the diagnosis and management of gout: integrating systematic literature review and expert opinion in the 3e Initiative[26] | 2015 | APLAR, Asia Pacific League of Associations for Rheumatology | Australian and New Zealand | International Journal of Rheumatic Diseases |
9 | 2015 Gout classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative[27] | 2015 | ACR/EULAR | USA and Europe | Annals of the Rheumatic Diseases |
10 | Portuguese recommendations for the diagnosis and management of Gout[28] | 2014 | A panel of 78 international rheumatologists in 3e (Evidence, Expertise, Exchange) Initiative | Portugal | PRÁTICA CLÍNICA |
11 | Clinical Practice Guidelines for Management of Gout[29] | 2013 | Spanish Society of Rheumatology | Spain | guipclingot |
12 | Multinational evidence-based recommendations for the diagnosis and management of gout: integrating systematic literature review and expert opinion of a broad panel of rheumatologists in the 3e initiative[30] | 2013 | 3e (Evidence, Expertise, Exchange) Initiative/A panel of international rheumatologists | International | Annals of the Rheumatic Diseases |
13 | Italian Society of Rheumatology recommendations for the management of gout[31] | 2013 | Italian Society of Rheumatology | Italy | Reumatismo |
14 | Management of chronic gout in adults[32] | 2012 | University of Texas | USA | National Guideline Clearinghouse |
15 | 1.2012 American College of Rheumatology Guidelines for Management of Gout. Part 1: Systematic Nonpharmacologic and Pharmacologic Therapeutic Approaches to Hyperuricemia[33] 2.2012 American College of Rheumatology Guidelines for Management of Gout. Part 2: Therapy and Anti-inflammatory Prophylaxis of Acute Gouty Arthritis[34] | 2012 | American College of Rheumatology | USA | Arthritis Care & Research |
16 | Japanese Guideline for the Management of Hyperuricemia and Gout: Second Edition[35] | 2011 | Tokyo Women's Medical University | Japan | Nucleosides, Nucleotides and Nucleic Acids |
17 | Management of initial gout in adults[36] | 2009 | University of Texas | USA | National Guideline Clearinghouse |
Overall reporting quality
The mean reporting rate of the 35 items was 14.9 (42.5%) and it ranged from nine (25.7%) to 22 (62.9%) for the 17 CPGs (Fig. 2). Of the 17 CPGs, only five (29.4%) had a reporting rate > 50%. The best one reported 62.9% of the items, while the poorest two reported < 26% of the 35 items.
Of the 35 items, the most frequently reported were #11a (Indicate whether the guideline is based on new systematic reviews done specifically for this guideline or whether existing systematic reviews were used), #12 (Describe the approach used to assess the certainty of the body of evidence), and #13c (Indicate the strength of the recommendations and the certainty of the supporting evidence), which were reported in 16 (94.1%) guidelines. These were followed by #13a (Provide clear, precise, and actionable recommendations), which was reported in 15 (88.2%) CPGs. Items #8b (Describe the setting(s) for which the guideline is intended, such as primary care, low- and middle-income countries, or inpatient facilities) and #17 (Indicate whether the guideline was subjected to a quality assurance process. If yes, describe the process) were reported in none of the CPGs (Fig. 3) (Table 2).
Table 2
Quality of the guidelines, according to the reporting of each item on the RIGHT checklist
| | 17 | 16 | 15 | 14 | 13 | 12 | 11 | 10 | 9 | 8 | 7 | 6 | 5 | 4 | 3 | 2 | 1 | |
| | 2009 FNPP | 2011 TWMU | 2012 ACR | 2012 FNPP | 2013 SIR | 2013 3E | 2013 SER | 2014 PORTUGAL | 2015ACR/EULAR | 2015 APLAR | 2016 T2T | 2016 EULAR | 2016 CMA | 2017 ACP | 2017 BSR | 2018 TRA | 2019 ELAR | total |
basic information | 1a | N | Y | Y | N | Y | Y | Y | Y | N | Y | Y | Y | Y | Y | Y | Y | Y | 14 |
1b | N | N | Y | N | N | N | N | N | Y | N | N | Y | Y | N | N | N | Y | 5 |
1c | Y | Y | Y | Y | Y | Y | Y | Y | Y | Y | N | Y | N | Y | N | N | Y | 13 |
2 | P | Y | Y | P | Y | Y | N | Y | Y | Y | Y | Y | N | Y | N | Y | Y | 12 |
3 | N | N | P | N | P | Y | Y | Y | N | N | Y | P | N | Y | N | Y | Y | 7 |
4 | N | Y | Y | N | Y | Y | N | Y | Y | Y | Y | Y | Y | Y | Y | Y | Y | 14 |
total | | 1 | 4 | 5 | 1 | 4 | 5 | 3 | 5 | 4 | 4 | 4 | 5 | 4 | 5 | 2 | 4 | 6 | 66 |
background | 5 | N | N | Y | N | Y | P | Y | N | Y | Y | N | P | Y | Y | Y | Y | P | 9 |
6 | N | Y | Y | Y | N | N | Y | P | N | P | P | N | N | Y | Y | N | P | 6 |
7a | Y | Y | Y | Y | N | N | N | N | Y | Y | Y | Y | Y | Y | Y | Y | Y | 13 |
7b | N | Y | N | N | N | N | N | N | N | N | N | Y | N | N | Y | N | N | 3 |
8a | Y | N | Y | Y | N | N | Y | N | N | N | N | P | Y | Y | Y | Y | P | 8 |
8b | N | N | N | N | N | N | N | N | N | N | N | N | N | N | N | N | P | 0 |
9a | N | N | Y | N | N | P | Y | P | N | Y | P | Y | P | Y | P | P | Y | 6 |
9b | N | N | P | P | P | P | Y | P | P | P | Y | Y | Y | Y | P | P | Y | 6 |
total | | 2 | 3 | 5 | 3 | 1 | 0 | 5 | 0 | 2 | 3 | 2 | 4 | 3 | 6 | 5 | 3 | 3 | 50 |
Evidence | 10a | N | N | Y | N | Y | Y | P | Y | N | Y | N | P | N | N | Y | Y | N | 7 |
10b | N | N | N | N | Y | N | N | N | N | N | Y | N | P | P | P | N | N | 2 |
11a | Y | Y | Y | Y | Y | Y | Y | Y | Y | Y | Y | Y | Y | Y | Y | N | Y | 16 |
11b | P | N | N | N | N | Y | P | N | N | N | N | N | P | Y | P | P | N | 2 |
12 | Y | Y | Y | Y | Y | Y | Y | Y | N | Y | Y | Y | Y | Y | Y | Y | Y | 16 |
total | | 2 | 2 | 3 | 2 | 4 | 4 | 2 | 3 | 1 | 3 | 3 | 2 | 2 | 3 | 3 | 2 | 2 | 43 |
Recommendations | 13a | P | Y | Y | P | Y | Y | Y | Y | Y | Y | Y | Y | Y | Y | Y | Y | Y | 15 |
13b | N | Y | N | N | N | N | N | N | N | N | N | Y | N | Y | Y | NA | NA | 4 |
13c | Y | Y | Y | Y | Y | Y | Y | Y | N | Y | Y | Y | Y | Y | Y | Y | Y | 16 |
14a | N | Y | N | N | N | N | N | N | N | Y | N | N | N | N | N | N | P | 2 |
14b | N | N | N | N | Y | N | N | N | N | N | N | N | NA | N | Y | N | P | 2 |
14c | N | N | N | N | Y | N | N | N | N | N | N | N | N | N | P | N | N | 1 |
15 | N | Y | Y | N | N | Y | Y | Y | Y | Y | Y | Y | P | N | Y | Y | Y | 12 |
total | | 1 | 5 | 3 | 1 | 4 | 3 | 3 | 3 | 2 | 4 | 3 | 4 | 2 | 3 | 5 | 3 | 3 | 52 |
review and quality assurance | 16 | Y | Y | N | N | N | N | N | N | N | N | P | P | N | Y | N | N | P | 3 |
17 | N | N | N | N | N | N | N | N | N | N | N | N | N | N | P | N | N | 0 |
total | | 1 | 1 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 1 | 0 | 0 | 0 | 3 |
Funding and declaration and management of interests | 18a | Y | N | Y | Y | N | Y | Y | N | Y | N | Y | N | N | Y | N | P | Y | 9 |
18b | N | NA | N | N | NA | N | Y | NA | N | NA | N | NA | NA | N | NA | N | N | 1 |
19a | N | N | Y | N | N | Y | Y | N | Y | N | Y | Y | Y | Y | Y | Y | Y | 11 |
19b | NA | NA | N | NA | NA | N | N | NA | N | N | N | P | NA | Y | NA | N | Y | 2 |
total | | 1 | 0 | 2 | 1 | 0 | 2 | 3 | 0 | 2 | 0 | 2 | 1 | 1 | 3 | 1 | 1 | 3 | 23 |
other information | 20 | Y | Y | Y | Y | N | Y | N | N | Y | N | Y | Y | N | Y | Y | N | Y | 11 |
21 | N | N | Y | N | N | N | N | N | N | N | N | Y | N | N | Y | N | N | 3 |
22 | N | N | Y | N | N | Y | N | N | N | P | N | N | N | N | N | N | N | 2 |
Total | | 1 | 1 | 3 | 1 | 0 | 2 | 0 | 0 | 1 | 0 | 1 | 2 | 0 | 1 | 2 | 0 | 1 | 16 |
| | 9 | 16 | 21 | 9 | 13 | 16 | 16 | 11 | 12 | 14 | 15 | 18 | 12 | 22 | 18 | 13 | 18 | 253 |
According to the RIGHT tool, the reporting rates of the seven domains (Basic information, Background, Evidence, Recommendations, Review and quality assurance, Statements and management of funds and interests, and Other information) were 64.7%, 36.8%, 50.6% 50.6%, 42.9%, 8.82%, 33.8%, and 31.4%, respectively.
Subgroup analysis
The mean number of reporting items of the nine guidelines developed by European countries was 15.2, and only three guidelines had a compliance rate of > 50% (33.3%); the mean number of reporting items in the four EULAR-generated CPGs was 15.8. For the six guidelines developed in the United States, the mean number of reporting items was 14.8. Two guidelines were prepared by the ACR, with a mean number of reporting items of 16.5, and two guidelines, which were published on NGC (National Guideline Clearinghouse), reported only nine items. Twenty-two items were reported in the American College of Physicians (ACP) guideline, which was the guideline with the largest number of reporting items among the 17 included in the analysis.
Eight guidelines were published between 2009 and 2014, which had a mean of 13.9 reporting items, and only one (12.5%) guideline had a compliance rate of more than 50%. Between 2015 and 2019, a total of nine guidelines were published, with a mean of 15.8 items being reported, but only four (44.4%) had a compliance rate of > 50%.
Analysis of each section of the RIGHT checklist
Basic information
With regard to the basic information, most of the CPGs could be judged by their title (82.4%), and the contact information for at least one author could be found (82.4%). The classification of the guideline could be easily discerned in 76.5% of the CPGs and a summary was presented in 70.5%. However, only 29.4% of the CPGs reported a publication date. Forty-one-point-two percent of the CPGs defined new terms and gave corresponding acronyms.
Background
The 17 CPGs did not comprehensively describe the background. More than half reported the epidemiology of gout (52.9%). Six (35.3%) guidelines reported the overall objectives of the guidelines and the specific objectives they were designed to achieve. Most of the guidelines described the main target population (76.5%), but only 17.6% described the subgroups that should be considered. Fewer than half (47.1%) of the guidelines described the key users and other potential users of the guidelines, and none described the specific target environment. Six (35.3%) CPGs listed all the contributors and their roles, and six (35.3%) gave the titles and affiliations of all the participants in their development, but only four (23.5%) contained both sets of information.
Evidence
Seven (41.2%) of the guidelines described the key findings on which the recommendations were based, but only two described the selection and classification of outcomes, and only one reported both. Sixteen (94.1%) guidelines described whether the systematic reviews on which the guidelines were based had been recently completed, but only two (11.8%) presented references, described how they were retrieved and evaluated, and stated whether they had been updated. Only one CPG did not describe the method of evaluation and grading of the quality of evidence.
Recommendations
Most of the guidelines (15, 80.2%) provided clear, accurate, and enforceable recommendations. Sixteen (94.1%) CPGs described the strength of the recommendation and the quality of the evidence supporting it, but only four provided recommendations for subgroups. Four CPGs took into account the preferences and values of the target group, two (11.8%) took into account cost and resource utilization, two (11.8%) took into account fairness, feasibility and acceptability, when creating their recommendations. Most of the guidelines (15, 88.2%) described the decision-making process and the methods used by the working group that created the guideline.
Review and quality assurance
Only three (17.6%) CPGs described whether they had been sent for review or not, and none described the level of supervision involved.
Funding and declaration and management of interests
More than half of the CPGs (9, 52.9%) described the sources of funding at each stage of their development, but only one described the role of the sponsor in the different stages of guideline formulation, as well as in the dissemination and implementation of the recommendations. Similarly, most of the CPGs (11, 64.7%) described the types of conflict of interest associated, but only two (11.8%) described the evaluation and management of these conflicts of interest and how users of the guidelines could obtain this information.
Other information
Eleven (64.7%) CPGs described where the guidelines, corresponding attachments, and other related documents could be obtained. However, only three (17.6%) articles described the differences between current practice and that recommended by research evidence, and/or provided recommendations for future research. In addition, only two CPGs described all the limitations associated with the formulation of the guidelines and their possible impact on the effectiveness of the recommendations.