ÓRGÃO OFICIAL DA SOCIEDADE PORTUGUESA DE REUMATOLOGIA 158 PRÁTICA CLÍNICA 1. Department of Rheumatology, Hospital de Egas Moniz, Centro Hospitalar de Lisboa Ocidental EPE 2. Institute of Microbiology, Faculdade de Medicina da Universidade de Lisboa 3. Department of Rheumatology, Hospital Garcia de Orta, Almada 4. Department of Rheumatology, Hospital Conde de Bertiandos, Ponte de Lima, Unidade Local de Saúde do Alto Minho EPE 5. Department of Rheumatology, Centro Hospitalar e Universitário de Coimbra EPE 6. Clinical Immunology & Rheumatology, AMC, Amsterdam, The Netherlands 7. CEDOC, Faculdade de Ciências Médicas da Universidade Nova de Lisboa 8. Rheumatology Research Unit, Instituto de Medicina Molecular, Faculdade de Medicina da Universidade de Lisboa 9. Rheumatology, Clínica Coração de Jesus, Lisboa prophylaxis; management of tophi and asymptomatic hyperuricaemia; the role of urine alkalinization; and the burden of gout. The level of agreement with the re- commendations ranged from 6.8 to 9.0 (mean 7.7) on a 1-10 point visual analogue scale, in which 10 stands for full agreement. Conclusion: The 12 Portuguese re- commendations for the Diagnosis and Management of Gout were formulated according to the best evidence and endorsed by a panel of 42 rheumatologists, enhan- cing their validity and practical use in daily clinical practice. Keywords: Recommendations; Portuguese; Gout. IntroductIon Gout is a common inflammatory arthropathy in which monosodium urate (MSU) crystals deposit in joints, lea- ding to self-limited arthritis and sometimes chronic de- forming arthropathy and tophi 1 . Although early treat- ment has improved the prognosis of gout, this clinical entity is still under diagnosed and poorly managed due to patient and physician suboptimal information 2 . The 3e Initiative (Evidence, Expertise, and Exchan- ge) is a multinational collaboration aimed at promo- ting evidence-based medicine through the formulation of recommendations addressing relevant clinical pro- blems. This initiative combines the evidence obtained from systematic literature reviews (SLR) with the clini- cal expertise of a broad panel of international rheuma- tologists 3, 4 . The objective of the 2011-2012 3e Initiati- ve was to develop practical recommendations for the Diagnosis and Management of Gout. After formulation of 10 multinational questions (and 2 additional natio- nal questions), the 12 Portuguese recommendations were proposed and voted in the national meeting in Lisbon. Portuguese recommendations for the diagnosis and management of Gout ACTA REUMATOL PORT. 2014:39;158-171 Araújo F 1,2 , Cordeiro I 3 , Teixeira F 4 , Rovisco J 5 , Ramiro S 3,6 , Mourão AF 1,6,7,8 , Costa JA 4 , Pimentão JB 9 , Malcata A 5 , Santos MJ 3,8 , Branco JC 7,1 AbstrAct Objective: To develop Portuguese evidence-based re- commendations for the Diagnosis and Management of Gout. Methods: As part of the 3e Initiative (Evidence, Expertise and Exchange), a panel of 78 international rheumatologists developed 10 relevant clinical ques- tions which were investigated with systematic literatu- re reviews. MEDLINE, EMBASE, Cochrane CENTRAL and abstracts from 2010-2011 EULAR and ACR mee- tings were searched. Based on the evidence found in the published literature, rheumatologists from 14 coun- tries developed national recommendations that were merged and voted into multinational recommenda- tions. We present the Portuguese recommendations for the Diagnosis and Management of Gout which were formulated and voted by Delphi method in April 2012, in Lisbon. The level of agreement and potential impact in clinical practice was also assessed. Results: Twelve national recommendations were elaborated from 10 in- ternational and 2 national questions. These recom- mendations addressed the diagnosis of gout; the treat- ment of acute flares and urate-lowering therapy; mo- nitoring of gout and comorbidity screening; the in- fluence of comorbidities in drug choice; lifestyle; flare