2024 Update of Chinese Guidelines for Diagnosis and Treatment of Hyperuricemia and Gout Part I: Recommendations for General Patients.

Yongli Yao, Jiajun Zhao, Changgui Li, Ronald M L Yip, Wen-Chan Tsai, Yaolong Chen, Hsiao-Yi Lin, Chao Liu, Huiyong Yin, Xinyu Li, Fengjing Liu, Zhen Liu, Zhifeng Cheng, Jidong Cheng, Ying Chen, Yuming Li, Kang Chen, Xiaochun Teng, Jiaqing Shao, Xiuyun Jiang, Dewen Yan, Ping Liu, Xiangyun Chang, Benli Su, Haibing Chen, Xingwu Ran, Dongbao Zhao, Yan Li, Can Wang, Zhaohui Lyu, Mingshu Sun

Journal: International journal of rheumatic diseases 2025;28(7):e70375

PMID: 40692263

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Abstract

BACKGROUND

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.

METHODS

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.

RESULTS

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.

CONCLUSIONS

These updated guidelines incorporate expert consensus and evidence to provide refined strategies for the diagnosis, prevention, and treatment of hyperuricemia and gout.

Address: 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.; Department of Metabolism, the Affiliated Hospital of Qingdao University, Qingdao, China.; Department of Endocrinology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.; Department of Rheumatology, the First Affiliated Hospital of Naval Medical University (Shanghai Changhai Hospital), Shanghai, China.; Department of Endocrinology, West China Hospital, Sichuan University, Chengdu, China.; Department of Endocrinology and Metabolism, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China.; Department of Endocrinology and Metabolism, Second Hospital of Dalian Medical University, Dalian, China.; Department of Endocrinology, the First Affiliated Hospital of Shihezi University, Xinjiang, China.; Department of Endocrinology, School of Medicine, the Second Affiliated Hospital, The Chinese University of Hong Kong, Shenzhen & Longgang District People's Hospital of Shenzhen, Shenzhen, China.; Department of Endocrinology, Shenzhen Second People's Hospital, the First Affiliated Hospital of Shenzhen University, Shenzhen, China.; Department of Endocrinology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China.; Department of Endocrinology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, China.; Department of Endocrinology and Metabolism, the First Hospital of China Medical University, Shenyang, China.; Department of Endocrinology, Qinghai Provincial People's Hospital, Xining, China.; Department of Endocrinology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology (HUST), Wuhan, China.; Department of Endocrinology, Xiang'an Hospital of Xiamen University, Xiamen, China.; Department of Endocrinology, the Fourth Affiliated Hospital of Harbin Medical University, Harbin, China.; Department of Endocrinology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.; Department of Endocrinology, Central Hospital of Dalian University of Technology (Dalian Municipal Central Hospital), Dalian, China.; Department of Biomedical Sciences, City University of Hong Kong, Hong Kong, China.; Department of Endocrinology, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, China.; Division of Allergy Immunology and Rheumatology, Cheng-Hsin General Hospital, National Yang Ming Chiao Tung University, Taipei, Taiwan.; Research Unit of Evidence-Based Evaluation and Guidelines, Chinese Academy of Medical Sciences (2021RU017), School of Basic Medical Sciences, Lanzhou University, Lanzhou, China.; Department of Rheumatology, Chung-Ho Memorial Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.; Tung Wah Group of Hospitals Integrated Diagnostic and Medical Centre, Kwong Wah Hospital, Kowloon, China.

DOI: 10.1111/1756-185x.70375