Serum Urate and Its Association With Gout Flares

• Published in: JAMA : the journal of the American Medical Association Vol. 331; no. 5; pp. 393 - 394
• Main Author: Gaffo, Angelo L
• Format: Journal Article
• Language: English
• Published: United States American Medical Association 06.02.2024
• Subjects: Arthritis; Autoimmune diseases; Cardiovascular diseases; Chronic illnesses; Crystals; Flares; Gout; Gout - blood; Gout - complications; Humans; Inflammation; Joint diseases; Kidney diseases; Metabolic disorders; Metabolic syndrome; Morbidity; Population studies; Rheumatoid arthritis; Symptom Flare Up; Uric acid; Uric Acid - blood
• ISSN: 0098-7484; 1538-3598
• DOI: 10.1001/jama.2023.20110

Gout is a chronic illness that has been underappreciated and poorly understood. It is more prevalent than rheumatoid arthritis and lupus but has lagged behind in research and quality of care. Poor clinical management of gout is associated with increased cardiovascular morbidity and mortality, chronic kidney disease, and metabolic syndrome. The main clinical manifestation of gout is intensely painful attacks of inflammatory arthritis known as gout flares. Elevated serum urate levels and the deposition of urate crystals in joints lead to the acute arthritis characteristic of gout. The association between serum urate levels and clinical manifestations of gout has been assumed but poorly supported by evidence. A recent study by McCormick et al using data from the UK Biobank found that higher serum urate levels were associated with significantly increased rates of gout flares. However, the study had limitations, including a lack of racial diversity and a sample that was not representative of the most commonly described gout populations. Future studies should be designed to test serum urate thresholds as treatment goals and their effect on meaningful clinical outcomes for patients with gout.