One- and 2-year Flare Rates After Treat-to-Target and Tight-Control Therapy of Gout

Results From the NOR-Gout Study

Till Uhlig; Lars F. Karoliussen; Joe Sexton; Tore K. Kvien; Espen A. Haavardsholm; Fernando Perez-Ruiz; Hilde Berner Hammer


Arthritis Res Ther. 2022;24(88) 

In This Article


Gout is the most prevalent inflammatory arthritis.[1] The disease is characterized by acute episodes of debilitating pain and joint inflammation, which current nomenclature defines as gout flares,[2] with a wide variation in the pattern of flare over time.[3] Gout confers an increased mortality as compared to the general population.[4]

Recurrent gout flares are associated with reduced health-related quality of life (HRQoL) and work participation,[5,6] and gout flares are also endorsed by OMERACT as a core outcome domain in long term clinical trials.[7] A patient-reported definition of flare has been suggested[8] and validated.[9]

Higher serum urate (SUA) levels and longer disease duration of gout have been considered to carry an elevated risk for acute gout flares, but there is variability with other factors involved, leaving us with limited knowledge on prognostic factors for recurrent gout flares.[10]

Long-term use of urate-lowering therapy (ULT) leads to crystal dissolution, reduces the risk of flare,[11] and prevents joint damage.[12] Recommendations suggest considering initiation with ULT already close to the time of diagnosis to reduce the frequency of gout flares and morbidity.[13,14] Gout flares are common after initiation of ULT,[15] and therefore prophylactic treatment with colchicine or non-steroidal anti-inflammatory drugs (NSAID for 3–6 months after start with ULT is recommended[13,14] to reduce new flares.[16–18]

Given sparse evidence regarding factors associated with gout flare during initiation and escalation of ULT in patients, we studied the incidence of gout flares over 2 years follow-up during ULT and examined predictors of flares in gout.