Serum uric acid control helps prevent gout flare in asymptomatic hyperuricaemia, gout

Patients with asymptomatic uricaemia or gout may do well to keep their serum uric acid (sUA) levels below 6.0 mg/dL, which has been shown to minimize the occurrences of gout flare in a recent study.

The study included 19,261 individuals with sUA ≥8.0 mg/dL and available 1-year data on disease status (prescriptions for urate-lowering therapy [ULT], occurrence of gout flare, sUA). They were followed for at least 2 years for the incidence rate of gout flare.

Patients were grouped into seven based on disease status. The largest subgroup comprised patients (n=10,480) with sUA <8.0 mg/dL at the follow-up visit and classified as ‘no treatment required’. The next largest subgroup (n=7,049) included those who were not receiving ULT, had no reported gout flare, and had sUA ≥8.0 mg/dL. There were 337 patients with asymptomatic hyperuricaemia, and 101 gout patients were on ULT and reached sUA of ≤6.0 mg/dL by the follow-up date.

Gout flare occurred less frequently among both gout and asymptomatic hyperuricaemia patients who achieved sUA ≤6.0 mg/dL with ULT than in those whose sUA persisted above the 6.0-mg/dL threshold or who were not receiving ULT.

In a Cox proportional hazard model, patients with asymptomatic hyperuricaemia on ULT (5.0< sUA ≤6.0 mg/dL) had the lowest risk of gout flare when compared with untreated patients (sUA ≥8.0 mg/dL; hazard ratio, 0.45, 95 percent confidence interval, 0.27–0.76).

More studies are needed to establish the benefits and drawbacks of using ULT to manage asymptomatic hyperuricaemia, both clinically and from the perspective of health economics.