Urate-Lowering Therapy for the Prevention and Treatment of Gout Flare

Jennifer A. Tilleman, RPh, PharmD, FASCP; Edward M. DeSimone II, RPh, PhD, FAPhA; Richard McAuliffe, 2017 PharmD Candidate


US Pharmacist. 2017;42(3):33-38. 

In This Article

Abstract and Introduction


Gout is one of the most common rheumatologic arthritic diseases in the United States. Preventing future gout attacks requires lowering serum urate levels to promote dissolution of urate crystals, which is accomplished by reducing the production of serum uric acid or promoting its excretion. Xanthene oxidase inhibitors (XOIs), including allopurinol and febuxostat, are first-line agents for the prevention of acute attacks. Probenecid, a uricosuric agent, is an appropriate adjunctive therapy or second-line agent when XOIs are contraindicated or poorly tolerated. Recently, several third-line agents (e.g., pegloticase, lesinurad) have become available for the treatment of refractory gout.


Gout is a rheumatologic arthritic disease that manifests itself after prolonged exposure to excessive levels of serum uric acid (hyperuricemia). Eventually, urate crystals precipitate and deposit into joint spaces. This process initiates an inflammatory reaction, which results in severe pain around the affected joints. Gout pain often presents in the distal joints. Pharmacologic goals include minimizing the inflammation and pain of an acute gout attack and preventing future gout flares. Initial urate-lowering therapy (ULT) usually consists of diet modification. Pharmacologic therapy lowers serum urate by either reducing the production or increasing the excretion of serum urate.[1]