2024 Update of Chinese Guidelines for Management of Hyperuricemia and Gout Part II: Recommendations for Patients With Common Comorbidities

Changgui Li¹, Mingshu Sun², Zhen Liu³, Detian Li⁴, Changqian Wang⁵, Zibin Tian⁶, Yuxiang Dai⁷, Zhe Feng⁸, Chengfu Xu⁹, Dongbao Zhao¹⁰, Feng Wei¹¹, Bo Ban¹², Chao Xie¹³, Zhenmei An¹⁴, Jia Liu¹⁵, Zhuo Li¹⁶, Yuwei He³, Xinde Li³, Fei Yan³, Lin Han³, Lidan Ma³, Xiaoyu Cheng³, Tian Liu³, Xufei Luo¹⁷, Lingling Cui³, Ying Gong³, Can Wang³, Yaolong Chen¹⁷, Zhaohui Lyu¹⁸, Ronald M L Yip¹⁹, Jiajun Zhao²⁰

Affiliations

¹ Department of Endocrinology, Xiang'an Hospital of Xiamen University, Xiamen, Fujian, China.
² Department of Rheumatology, Xiang'an Hospital of Xiamen University, Xiamen, Fujian, China.
³ Department of Metabolism, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China.
⁴ Department of Nephrology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China.
⁵ Department of Cardiology, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
⁶ Department of Gastroenterology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China.
⁷ Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, China.
⁸ Department of Nephrology, The First Medical Center of Chinese PLA General Hospital, Beijing, China.
⁹ Department of Gastroenterology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.
¹⁰ Department of Rheumatology, The First Affiliated Hospital of Naval Medical University (Shanghai Changhai Hospital), Shanghai, China.
¹¹ Department of Endocrinology, The First Affiliated Hospital of Baotou Medical College, Inner Mongolia University of Science and Technology, Baotou, Neimonggu, China.
¹² Department of Endocrinology, Affiliated Hospital of Jining Medical University, Jining, Shandong, China.
¹³ Department of Endocrinology and Metabolism, Peking University Third Hospital, Beijing, China.
¹⁴ Department of Metabolism, West China Hospital, Sichuan University, Chengdu, China.
¹⁵ Department of Endocrinology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China.
¹⁶ Department of Endocrinology and Metabolism, The First Hospital of Jilin University, Changchun, Jilin, China.
¹⁷ Research Unit of Evidence-Based Evaluation and Guidelines, Chinese Academy of Medical Sciences (2021RU017), School of Basic Medical Sciences, Lanzhou University, Lanzhou, Gansu, China.
¹⁸ Department of Endocrinology, The First Medical Center of Chinese PLA General Hospital, Beijing, China.
¹⁹ Tung Wah Group of Hospitals Integrated Diagnostic and Medical Centre, Kwong Wah Hospital, Kowloon, Hong Kong, China.
²⁰ Department of Endocrinology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China.

PMID: 40851321
PMCID: PMC12375887
DOI: 10.1111/1756-185x.70402

Practice Guideline

2024 Update of Chinese Guidelines for Management of Hyperuricemia and Gout Part II: Recommendations for Patients With Common Comorbidities

Changgui Li et al. Int J Rheum Dis. 2025 Aug.

. 2025 Aug;28(8):e70402.

doi: 10.1111/1756-185x.70402.

Authors

Affiliations

¹ Department of Endocrinology, Xiang'an Hospital of Xiamen University, Xiamen, Fujian, China.
² Department of Rheumatology, Xiang'an Hospital of Xiamen University, Xiamen, Fujian, China.
³ Department of Metabolism, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China.
⁴ Department of Nephrology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China.
⁵ Department of Cardiology, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
⁶ Department of Gastroenterology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China.
⁷ Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, China.
⁸ Department of Nephrology, The First Medical Center of Chinese PLA General Hospital, Beijing, China.
⁹ Department of Gastroenterology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.
¹⁰ Department of Rheumatology, The First Affiliated Hospital of Naval Medical University (Shanghai Changhai Hospital), Shanghai, China.
¹¹ Department of Endocrinology, The First Affiliated Hospital of Baotou Medical College, Inner Mongolia University of Science and Technology, Baotou, Neimonggu, China.
¹² Department of Endocrinology, Affiliated Hospital of Jining Medical University, Jining, Shandong, China.
¹³ Department of Endocrinology and Metabolism, Peking University Third Hospital, Beijing, China.
¹⁴ Department of Metabolism, West China Hospital, Sichuan University, Chengdu, China.
¹⁵ Department of Endocrinology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China.
¹⁶ Department of Endocrinology and Metabolism, The First Hospital of Jilin University, Changchun, Jilin, China.
¹⁷ Research Unit of Evidence-Based Evaluation and Guidelines, Chinese Academy of Medical Sciences (2021RU017), School of Basic Medical Sciences, Lanzhou University, Lanzhou, Gansu, China.
¹⁸ Department of Endocrinology, The First Medical Center of Chinese PLA General Hospital, Beijing, China.
¹⁹ Tung Wah Group of Hospitals Integrated Diagnostic and Medical Centre, Kwong Wah Hospital, Kowloon, Hong Kong, China.
²⁰ Department of Endocrinology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China.

PMID: 40851321
PMCID: PMC12375887
DOI: 10.1111/1756-185x.70402

Abstract

Objective: The aim of this updated guideline is to provide comprehensive recommendations for the management of gout in patients with common comorbidities, such as chronic kidney disease (CKD), cardiovascular disease (CVD), diabetes, osteoarthritis (OA), and gastrointestinal disorders.

Methods: This guideline was developed by a multidisciplinary expert panel consisting of specialists in endocrinology, rheumatology, nephrology, cardiology, gastroenterology, and methodology. The development process adhered to standard methodologies, including PICO (population, intervention, comparator, and outcomes) question deconstruction, systematic literature review, the Grading of Recommendations Assessment, Development and Evaluation (GRADE) for evidence and recommendation evaluation, Delphi voting, and expert consensus.

Results: The guideline presents 26 evidence-based recommendations addressing seven clinical questions for patients with hyperuricemia and gout in the context of comorbidities. Key recommendations include the maintenance of strict serum urate targets, particularly for patients with CKD stage ≥ 3, chronic gouty arthritis, and OA, in order to prevent disease progression. In patients with CVD or diabetes, intra-articular triamcinolone is preferred over systemic glucocorticoids. Prioritized anti-inflammatory treatments for patients with CKD, gastrointestinal diseases, and OA are recommended. The guideline also introduces emerging therapies, such as interleukin-1 inhibitors and selective urate transport inhibitors, as potential treatment options for refractory cases.

Conclusion: The update offers a comprehensive, patient-centered approach to managing gout, particularly in individuals with associated comorbidities. Multidisciplinary collaboration and emerging new treatments and evidence ensure the optimization of the recommendations.

Keywords: comorbidity; gout; guideline; hyperuricemia; management.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

**FIGURE 1**
Flow chart of recommendations.

See this image and copyright information in PMC

References

1. FitzGerald J. D., Dalbeth N., Mikuls T., et al., “2020 American College of Rheumatology Guideline for the Management of Gout,” Arthritis & Rhematology 72, no. 6 (2020): 879–895. - PubMed
1. Endocrinology, C.S.o , “Guideline for the Diagnosis and Treatment of Hyperuricemia and Gout in China (2019),” Chinese Journal of Endocrinology and Metabolism 36, no. 1 (2020): 13.
1. Liu S., Sun H., Yang S., et al., “Clustering of Gout‐Related Comorbidities and Their Relationship With Gout Flares: A Data‐Driven Cluster Analysis of Eight Comorbidities,” Journal of Endocrinological Investigation 47, no. 5 (2024): 1119–1128. - PubMed
1. Howard R. G., Samuels J., Gyftopoulos S., et al., “Presence of Gout Is Associated With Increased Prevalence and Severity of Knee Osteoarthritis Among Older Men: Results of a Pilot Study,” Journal of Clinical Rheumatology 21, no. 2 (2015): 63–71. - PMC - PubMed
1. Loustau C., Rosine N., Forien M., et al., “Effectiveness and Safety of Anakinra in Gout Patients With Stage 4‐5 Chronic Kidney Disease or Kidney Transplantation: A Multicentre, Retrospective Study,” Joint, Bone, Spine 85, no. 6 (2018): 755–760. - PubMed

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2024 Update of Chinese Guidelines for Management of Hyperuricemia and Gout Part II: Recommendations for Patients With Common Comorbidities

Affiliations

2024 Update of Chinese Guidelines for Management of Hyperuricemia and Gout Part II: Recommendations for Patients With Common Comorbidities

Authors

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Abstract

Conflict of interest statement

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