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

Publication ,  Journal Article
Hershfield, MS
Published in: Curr Opin Rheumatol
March 2009

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.

Duke Scholars

Published In

Curr Opin Rheumatol

DOI

EISSN

1531-6963

Publication Date

March 2009

Volume

21

Issue

2

Start / End Page

138 / 142

Location

United States

Related Subject Headings

  • Uric Acid
  • Oxidative Stress
  • Humans
  • Gout Suppressants
  • Gout
  • Crystallization
  • Arthritis & Rheumatology
  • 3202 Clinical sciences
  • 1103 Clinical Sciences
 

Citation

APA
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ICMJE
MLA
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Hershfield, M. S. (2009). Reassessing serum urate targets in the management of refractory gout: can you go too low? Curr Opin Rheumatol, 21(2), 138–142. https://doi.org/10.1097/BOR.0b013e3283257b83
Hershfield, Michael S. “Reassessing serum urate targets in the management of refractory gout: can you go too low?Curr Opin Rheumatol 21, no. 2 (March 2009): 138–42. https://doi.org/10.1097/BOR.0b013e3283257b83.
Hershfield MS. Reassessing serum urate targets in the management of refractory gout: can you go too low? Curr Opin Rheumatol. 2009 Mar;21(2):138–42.
Hershfield, Michael S. “Reassessing serum urate targets in the management of refractory gout: can you go too low?Curr Opin Rheumatol, vol. 21, no. 2, Mar. 2009, pp. 138–42. Pubmed, doi:10.1097/BOR.0b013e3283257b83.
Hershfield MS. Reassessing serum urate targets in the management of refractory gout: can you go too low? Curr Opin Rheumatol. 2009 Mar;21(2):138–142.

Published In

Curr Opin Rheumatol

DOI

EISSN

1531-6963

Publication Date

March 2009

Volume

21

Issue

2

Start / End Page

138 / 142

Location

United States

Related Subject Headings

  • Uric Acid
  • Oxidative Stress
  • Humans
  • Gout Suppressants
  • Gout
  • Crystallization
  • Arthritis & Rheumatology
  • 3202 Clinical sciences
  • 1103 Clinical Sciences