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Rheumatology 2009 48(Supplement 2):ii9-ii14; doi:10.1093/rheumatology/kep087
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© The Author 2009. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

This article appears in the following Rheumatology issue: Can we make gout crystal clear? Proceedings of a satellite symposium held on the occasion of the EULAR Congress, Paris, France, June 13, 2008 [View the issue table of contents]

Treating to target: a strategy to cure gout

Fernando Perez-Ruiz1

1Rheumatology Division, Hospital de Cruces, Vizcaya, Spain

Correspondence to: Fernando Perez-Ruiz, Rheumatology Division, Hospital de Cruces, 48600 Baracaldo, Vizcaya, Spain. E-mail: fernando.perezruiz{at}osakidetza.net


  Abstract

Acute gout attacks and the long-term complications of gout are associated with the deposition of monosodium urate (MSU) monohydrate crystals in the joints and soft tissues, causing acute and chronic inflammation. The aim of long-term treatment is to reduce the serum urate (sUA) level to 6 mg/dl (<=360 µmol/l), below the saturation point of MSU, so that new crystals cannot form and existing crystals are dissolved. Serial joint aspiration studies confirmed the disappearance of crystals with effective urate-lowering therapy. There is good evidence that achieving sUA <6 mg/dl (360 µmol/l) results in freedom from acute gout attacks, and shrinkage and eventual disappearance of tophi. Gout patients must be informed about their diagnosis and educated about gout management including the importance of compliance with long-term treatment. Patients starting urate-lowering therapy need to understand the importance of prophylactic therapy with colchicine or NSAIDs to reduce the risk of ‘mobilization flares’ in the first few months. In the long term, reduction in the sUA below the target level will result in gout being effectively cured.

KEY WORDS: Gout, Monosodium urate, Urate-lowering, Treatment target, Arthrocentesis, Crystals, Tophi, Cure

Submitted 18 December 2008; revised version accepted 18 March 2009.
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