Medication adherence in gout is low, and discontinuation of urate-lowering therapy puts patients at risk of flares and cardiovascular events. A strategy to regularly monitor serum urate levels and the dissolution of urate deposits (particularly if visualized by patients) might encourage adherence in the long term.
This is a preview of subscription content, access via your institution
Access options
Access Nature and 54 other Nature Portfolio journals
Get Nature+, our best-value online-access subscription
$29.99 / 30 days
cancel any time
Subscribe to this journal
Receive 12 print issues and online access
$209.00 per year
only $17.42 per issue
Buy this article
- Purchase on Springer Link
- Instant access to full article PDF
Prices may be subject to local taxes which are calculated during checkout
References
Stamp, L. K. et al. Association between serum urate and flares in people with gout and evidence for surrogate status: a secondary analysis of two randomised controlled trials. Lancet Rheumatol. 4, E53–E60 (2022).
O’Dell, J. R. et al. Comparative effectiveness of allopurinol and febuxostat in gout management. NEJM Evid. https://doi.org/10.1056/evidoa2100028 (2022).
Russell, M. D. et al. Management of gout following 2016/2017 European (EULAR) and British (BSR) guidelines: An interrupted time-series analysis in the United Kingdom. Lancet Reg. Health Eur. 18, 100416 (2022).
Dehlin, M., Jacobsson, L. & Roddy, E. Global epidemiology of gout: prevalence, incidence, treatment patterns and risk factors. Nat. Rev. Rheumatol. 16, 380–390 (2020).
Hammer, H. B. et al. Ultrasound shows rapid reduction of crystal depositions during a treat-to-target approach in gout patients: 12-month results from the NOR-Gout study. Ann. Rheum. Dis. 79, 1500–1505 (2020).
Ives, A. et al. Xanthine oxidoreductase regulates macrophage IL1β secretion upon NLRP3 inflammasome activation. Nat. Commun. 6, 6555 (2015).
Perez-Ruiz, F., Herrero-Beites, A. M. & Carmona, L. A two-stage approach to the treatment of hyperuricemia in gout: the “dirty dish” hypothesis. Arthritis Rheum. 63, 4002–4006 (2011).
Cipolletta, E. et al. Association between gout flare and subsequent cardiovascular events among patients with gout. JAMA 328, 440–450 (2022).
Doherty, M. et al. Efficacy and cost-effectiveness of nurse-led care involving education and engagement of patients and a treat-to-target urate-lowering strategy versus usual care for gout: a randomised controlled trial. Lancet 392, 1403–1412 (2018).
Cipolletta, E., Abhishek, A., Di Battista, J., Grassi, W. & Filippucci, E. Ultrasonography in the prediction of gout flares: a 12-month prospective observational study. Rheumatology (Oxford) 62, 1108–1116 (2023).
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Competing interests
P.R. received fees from Horizon. N.D. received fees from AstraZeneca, Novartis, Horizon, Selecta, Arthrosi, JW Pharmaceutical Corporation, PK Med, LG Chem, JPI, PTC Therapeutics, Protalix, Unlocked Labs, Hikma, Dexcel Pharma, Shanton Pharma and Avalo outside the submitted work.
Supplementary information
Rights and permissions
About this article
Cite this article
Richette, P., Dalbeth, N. Treat-to-target or treat-to-dissolve strategy to improve gout treatment. Nat Rev Rheumatol (2024). https://doi.org/10.1038/s41584-024-01117-5
Published:
DOI: https://doi.org/10.1038/s41584-024-01117-5