Preventing gout attacks by lowering serum urate levels

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Preventing gout attacks by lowering serum urate levels

Rheumawire

Jul 8, 2004

Mann

Tokyo, Japan - In patients with gout, using antihyperuricemic drugs to

reduce serum-urate concentrations to <6 mg/dL will eventually result in

a reduced frequency of gouty attacks and may prevent future attacks,

according to a new study in the June 15, 2004 issue of Arthritis &

Rheumatism [1].

Moreover, researchers suggest that patients who have had high

serum-urate levels for a long duration and who have a history of gouty

attacks should be regarded as " high-risk " patients and should be treated

with antihyperuricemic drugs such as allopurinol.

Dr Akira Shoji (Tokyo Women's Medical University, Tokyo, Japan) and

colleagues report a retrospective study in 267 patients who had had at

least 1 gouty attack before visiting their clinic. The researchers

compiled data on serum-urate concentrations, history of recurrent gouty

attacks, and information about antihyperuricemic drug use on each visit

for up to 3 years. They found that a reduction of serum-urate

concentration to <6 mg/dL and antihyperuricemic drug use were each

significantly associated with a reduced risk of gouty attacks. Among 81

patients with average serum-urate concentrations of <6.0 mg/dL, all in

the medication group, 71 patients (86%) had no recurrent gouty attacks

during the study, they note.

" The study demonstrated that the lower the serum-urate levels, the less

likelihood of recurrent acute gouty attacks, " Shoji concludes. " We

recommend a target serum urate level of <6 mg/dL as an aim of

hyperuricemic therapy for purposes of reducing the incidence of acute

arthritic attacks in patients with gout. "

" We always had that feeling [that serum-urate concentrations of <6 mg/dL

will reduce frequency and/or prevent of future gouty attacks], but there

have not been any decent studies on a large number of patients to see

whether that's true, " Dr Yusuf Yazici (Long Island College Hospital,

Brooklyn NY) tells rheumawire. Until now.

" No one really knew before how low you need to go, " he says. " A lot of

times if patients have a serum-urate level of 10 mg/dL we start them on

medications and the level comes down to 9 mg/dL and they have no more

attacks, so we keep them at 9 mg/dL, but this study makes the argument

that, just like cholesterol and blood pressure, lower is better, " he

says.

Calling the new study " well done, " he says it supports the argument to

start patients on allopurinol sooner. " I think we may see a trend toward

treating people with 1 attack to bring down their high uric levels

down, " he says.

Source

Shoji A, Yamanaka H, Kamatani N. A retrospective study

of the relationship between serum urate level and recurrent attacks of

gouty arthritis: evidence for reduction of recurrent gouty arthritis

with antihyperuricemic therapy. Arthritis Rheum 2004; 51:321-325.

I'll tell you where to go!

Mayo Clinic in Rochester

http://www.mayoclinic.org/rochester

s Hopkins Medicine

http://www.hopkinsmedicine.org