What is the goal of the long-term management of gout?

Updated: Jan 26, 2021
  • Author: Bruce M Rothschild, MD; Chief Editor: Herbert S Diamond, MD  more...
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Long-term management of gout is focused on lowering uric acid levels. The goal of therapy is to reduce serum uric acid levels to below 6 mg/dL, at minimum. In many cases, lowering uric acid levels to less than 5 mg/dL is necessary to improve the signs and symptoms of gout. ACR guidelines recommend that once palpable tophi and all acute and chronic gout symptoms have resolved, urate-lowering therapy should be continued indefinitely, if it is well-tolerated and not burdensome. [127]

Perez-Ruiz et al have proposed that once dissolution of existing urate crystals has been achieved, less stringent control may suffice to prevent formation of new crystals. [151] In their prospective cohort study of 211 patients from whom urate-lowering therapy was withdrawn either after 5 years if no tophus was present at baseline or 5 years after resolution of the last tophus, no patient who maintained an average serum urate level lower than 7 mg/dL developed a crystal-proven recurrence of gout.

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