Reassessing serum urate targets in the management of refractory gout: can you go too low?

Published

Journal Article (Review)

PURPOSE OF REVIEW: Growing awareness of patients with refractory gout is prompting a reassessment of treatment strategy. This article reviews the current practice of targeting serum urate concentrations (sUA) in the mid-normal range (roughly 4-6 mg/dl) and considers the rationale for more aggressively lowering sUA in patients with poorly controlled chronic gout. Some hypothetical concerns with inducing hypouricemia are considered and relevant clinical evidence is evaluated. RECENT FINDINGS: Recent studies confirm the benefits of modestly reducing sUA in many gout patients. However, tophi and tissue stores of monosodium urate crystals resolve slowly, particularly in patients with longstanding disease. Consistent with physicochemical principles, the rate of decrease in tophus size increases with a reduction in sUA concentration over a broad range. Reducing sUA to near or below 2 mg/dl can be achieved in some patients with current urate-lowering drugs, but new drugs now under investigation may be more effective. As a free radical scavenger, uric acid has been postulated to protect from oxidative stress. However, inherited disorders associated with profound, lifelong hypouricemia indicate that maintaining sUA near or below 2 mg/dl would probably be safe. SUMMARY: Targeting low sUA could improve the elimination of tissue urate stores and achieve better control of disease in patients with refractory gout.

Full Text

Duke Authors

Cited Authors

  • Hershfield, MS

Published Date

  • March 2009

Published In

Volume / Issue

  • 21 / 2

Start / End Page

  • 138 - 142

PubMed ID

  • 19339924

Pubmed Central ID

  • 19339924

Electronic International Standard Serial Number (EISSN)

  • 1531-6963

Digital Object Identifier (DOI)

  • 10.1097/BOR.0b013e3283257b83

Language

  • eng

Conference Location

  • United States