Clinical Practice Consensus Statement 2025: Management of Hyperuricemia and Gout in Adolescents

Background

In response to the increasing global prevalence of gout, there is a concerning shift towards a younger demographic, with China at the forefront of this trend. Hyperuricemia, a central factor in the pathogenesis of gout, is becoming increasingly common among adolescents, particularly males, and is associated with various health risks, including joint pain, CKD, metabolic disorders, and premature death. Despite the seriousness of this issue, there is a lack of specific guidelines addressing adolescent and hyperuricemia gout management.

Methods

The working comprising 26 clinician pediatricians, rheumatologists, and endocrinologists, all experienced in the clinical presentation and management of gout and hyperuricemia, was convened to develop a consensus. A systematic literature search was conducted in PubMed, the Cochrane Library, and EMBASE published from 1 January 1960 to 31 May 2024. Two rounds of Delphi surveys for each recommendation were conducted among all group members via electronic questionnaire.

Results

Adolescent-onset gout is characterized by a pronounced genetic predisposition and distinct environmental influences, with a significant number of cases reporting a positive family history. We issued three consensus statements with five recommendations including the criteria, the urate-lowering treatment, and flare therapy principles for hyperuricemia and gout in adolescents.

Conclusions

This consensus statement comprehensively delves into the critical clinical challenges associated with gout and hyperuricemia in the adolescent population, emphasizing the pressing requirement for improved detection and management strategies to support a demographic that may be underserved by the healthcare system.