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

Journal: International Journal of Rheumatic Diseases, 2025, 28(7): e70378 DOI:10.1111/1756‑185X.70378 Working Group: Chinese Society of Endocrinology; 26 experts (pediatrics, rheumatology, endocrinology) Adolescent definition: WHO 10‑19 years oldPMC

⚠️ This is structured key summary, not full‑text reproduction. For original full‑text, refer to PMC/PubMed.

Abstract

Background The global prevalence of gout is rising with prominent younger‑onset trend in China. Hyperuricemia is highly prevalent among adolescents (especially males), associated with gout, chronic kidney disease, metabolic comorbidities and premature mortality. No dedicated international guidelines for adolescent gout exist.

Methods Systematic literature search (PubMed, Cochrane, EMBASE: 1960‑May 2024). Two‑round Delphi survey to formulate consensus statements.

Results Adolescent‑onset gout shows strong genetic predisposition and positive family history. Three consensus statements with five key recommendations cover diagnostic criteria, urate‑lowering therapy (ULT), and acute gout flare management.

Conclusion This consensus addresses clinical gaps for adolescent hyperuricemia/gout and supports standardized care for this under‑recognized populationPMC.

Keywords: adolescents; consensus; gout; hyperuricemia; management

1. Consensus Statement Ⅰ: Diagnostic Criteria

1.1 Hyperuricemia in adolescents

• Use adult cut‑off: fasting serum urate ≥420 μmol/L on two separate days under regular diet (2C)PMC.

1.2 Gout classification for adolescents

• Apply the 2015 ACR/EULAR gout classification criteria (2C)PMC.
• Baseline work‑up: serum urate, renal function, urinary uric acid excretion typing, lipid/glucose metabolism screening; renal ultrasound.

Note: Adolescent patients have higher proportion of urate underexcretion phenotype compared with adults; renal urate excretion typing is strongly recommended before initiating ULTPMC.

2. Consensus Statement Ⅱ: Principles of Urate‑Lowering Therapy (ULT)

Indications for ULT in adolescents

• Definite gout (≥1 flare, tophi, urate crystal proven arthropathy, renal urate stones).
• Asymptomatic hyperuricemia: Drug ULT is NOT routinely recommended. Prioritize lifestyle modification. Pharmacological intervention may be considered only when persistent markedly elevated SUA plus organ injury (renal damage, metabolic complications).

Treatment target

• Serum urate target: <360 μmol/L; for tophaceous gout: <300 μmol/L. Avoid SUA below 180 μmol/L.

Drug selection

1. Underexcretion type: Uricosuric agents (benzbromarone, monitor liver function). Ensure adequate fluid intake.
2. Over‑production type: Xanthine oxidase inhibitors (allopurinol as first‑line; febuxostat alternative). Start low‑dose titration.
3. Lifestyle: Dietary restriction should not be excessively strict, given adolescent growth‑and‑development requirements. Weight management, limit sugary beverages; avoid alcohol.

Prophylaxis during ULT initiation

• Low‑dose colchicine for flare prophylaxis during ULT titration. Limited pediatric pharmacokinetic data; dose must be weight‑adjusted.

3. Consensus Statement Ⅲ: Management of Acute Gout Flare

1. First‑line options: NSAIDs or colchicine, weight‑based dosing.
2. Systemic glucocorticoids: Reserved for refractory cases or contra‑indications to above agents; avoid long‑term use. Intra‑articular steroid injection is preferred for mono‑articular flare.
3. Do NOT initiate ULT during acute flare; ULT should be started after inflammation subsides. If patient is already on ULT, do NOT discontinue during flare.

4. Monitoring and long‑term follow‑up

• Regular monitoring: serum urate, renal function, liver enzymes, urine pH, metabolic indices.
• Screen for comorbidities: obesity, insulin resistance, fatty liver, nephrolithiasis.
• Family screening is encouraged given high familial clustering in adolescent‑onset disease.

5. Special warnings

1. Pharmacokinetic and safety data for anti‑gout medications in adolescents remain limited. Use off‑label drugs with careful risk‑benefit evaluation and informed consent.
2. Diet restriction must balance metabolic control versus adolescent nutritional needs for growth; avoid over‑restriction.
3. Urate‑excretion typing guides personalized drug selection in youth gout patientsPMC.