Treating Hyperuricemia
Gout should be considered a chronic disease that requires chronic therapy. It should be managed like any other chronic disease. Serum uric acid levels need constant monitoring because the degree of hyperuricemia is related to the risk of developing gout, the recurrence of attacks, and the development of long-term complications. Treatment of hyperuricemia in gout requires a lifelong commitment.
The specific decision to initiate urate-lowering drug therapy for patients with gout is based in part on the history of previous attacks of acute gout, the degree of hyperuricemia present, consideration of modifiable factors (eg, diet, alcohol, and other drugs), and the presence of tophi.
Intermittent adherence to urate-lowering therapy may result in fluctuations of serum urate level, which may precipitate additional acute gout attacks. Studies have found that the clinical manifestations of gout return with intermittent therapy or withdrawal of urate-lowering therapy.
Data on chronic treatment of hyperuricemia in patients with gout have supported its efficacy across a variety of measures and suggest a treatment serum urate target of < 6 mg/dL. Review the evidence.