Photograph of a person's legs lying on a coach with the bottom of a foot inflamed from a gout flare
Credit: iStock/Staras

Key Takeaways

  • Having low levels of uric acid, a metabolism byproduct, can reduce your risk of having gout flares.
  • Following a treat-to-target approach in gout means picking a goal uric acid level and adjusting medication doses until you reach it.
  • This approach is linked with a much lower risk of having future gout flares than that of people who took uric acid-lowering medication but without following treat to target.

Most people with gout, an inflammatory form of arthritis, find out that they have it after enduring a flare. Uric acid (urate) levels get too high in the bloodstream and form crystals, which settle in the joints and trigger a painful inflammation response.

Treating a gout flare — often with non-steroidal anti-inflammatory pain relievers, steroids, or the drug colchicine — relieves acute symptoms like redness and severe pain, but that doesn’t mean the underlying problem has resolved. To prevent future flares, doctors generally prescribe a maintenance medication like allopurinol to keep uric acid levels down. But is aiming for a specific uric acid level in the blood important in managing gout?

Many doctors believe that keeping uric acid below 6 mg/dL is beneficial, but whether or not a patient’s medication dose should be adjusted for the specific purpose of meeting that goal (versus focusing on the reemerge of symptoms) has been controversial. Now a study supports using such a treat-to-target approach. Treating to target means picking a goal uric acid level and adjusting a patient’s medication dose until it is reached.

The research, which appears in The Lancet Rheumatology, analyzed data from two trials on people with gout in the UK and New Zealand who took urate-lowering medication. By combining information on participants from both these trials, researchers identified 343 gout patients whose urate levels stayed below 6 mg/dL for two years, as well as an additional 245 gout patients whose urate levels were higher.

According to the findings, patients in the lower urate group were significantly less likely to have frequent flares during the 12 months after they started treatment. During the subsequent 12 months (from one to two years), the risk of having a flare was 71 percent lower among the low urate group.

Also worth noting: Many who kept their urate levels below 6 mg/dL had shrinkage of tophi, which are large, visible bumps comprised of urate crystals.

“Achieving [a urate level of less than 6 mg/dL] is clearly associated with fewer gout flares in the ensuing months in those with gout,” rheumatologist Jack Cush, MD, wrote on RheumNow. “These data strongly support a treat-to-target serum urate approach in the management of gout.”

Found This Study Interesting? Get Involved

If you are diagnosed with arthritis or another musculoskeletal condition, we encourage you to participate in future studies by joining CreakyJoints’ patient research registry, ArthritisPower. ArthritisPower is the first-ever patient-led, patient-centered research registry for joint, bone, and inflammatory skin conditions. Learn more and sign up here.

Cush J. Does T2T Lead to Fewer Gout Flares? RheumNow. January 17, 2022. https://rheumnow.com/news/does-t2t-lead-fewer-gout-flares.

Stamp LK, et al. Association Between Serum Urate and Flares in People with Gout and Evidence for Surrogate Status: a Secondary Analysis of Two Randomised Controlled Trials. The Lancet Rheumatology. January 2022. doi: ttps://doi.org/10.1016/S2665-9913(21)00319-2.