Critical appraisal of serum urate targets in the management of gout

• Published in: Nature reviews. Rheumatology Vol. 18; no. 10; pp. 603 - 609
• Main Authors: Stamp, Lisa K, Dalbeth, Nicola
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group 01.10.2022
• Subjects: Clinical outcomes; Clinical trials; Content analysis; Disease; Gout; Lead poisoning; Remission (Medicine); Rheumatism; Rheumatology; Ultrasonic imaging; Uric acid
• ISSN: 1759-4790; 1759-4804
• DOI: 10.1038/s41584-022-00816-1

Gout management involves two broad aspects: treatment of gout flares to provide rapid symptomatic relief and long-term urate-lowering therapy to lower serum urate sufficiently to prevent gout flares from occurring. All of the major rheumatology societies recommend a target serum urate of <5 mg/dl (<0.30 mmol/l) or <6 mg/dl (<0.36 mmol/l), both of which are below the point of saturation for urate and therefore lead to monosodium urate crystal dissolution. In this Review, we describe the rationale for treat-to-target urate approach in the long-term management of gout and the current evidence and controversy around the appropriate serum urate targets.Gout can be effectively treated with long-term urate-lowering therapy. Current guidelines advocate the use of a treat-to-target serum urate strategy, with a target serum urate concentration of <5 mg/dl (<0.30 mmol/l) or <6 mg/dl (<0.36 mmol/l), but specific targets are under debate. In this Review, the authors consider the rationale and evidence for the recommendations.