Gout Urate-Lowering Therapy: Indications & Targets — free guideline decision tool

This tool decides whether to start urate-lowering therapy (ULT) in gout and sets the serum-urate target, based on urate level and comorbidities per the 2019 Chinese hyperuricemia/gout guideline.

Initiate if urate ≥ 480, or ≥ 420 with flares ≥ 2/yr, tophi, nephrolithiasis, CKD, hypertension, diabetes, dyslipidemia, cardio-cerebrovascular disease, or onset < 40 yr. Target < 360 µmol/L; < 300 with severe disease; not chronically < 180.

Use to determine ULT initiation and target: serum urate ≥ 480 µmol/L starts ULT, ≥ 420 with high-risk features starts ULT, and the target is < 360 (or < 300 with tophi/frequent flares).

ULT is started after an acute flare resolves but is never stopped during a flare in established users, with low-dose colchicine for flare prophylaxis at initiation. (original synthesis · not guideline verbatim) The target tightens to < 300 µmol/L when tophi, chronic gouty arthritis, or frequent flares are present. Before allopurinol in Han Chinese patients, test HLA-B*5801 to reduce severe cutaneous reaction risk.

For licensed clinicians and clinical researchers. Interpret results with history, investigations and local protocols; not a diagnosis or prescription, and not a substitute for multidisciplinary decision-making or local guidelines.

Inputs: Serum urate 500 µmol/L, Gout flares ≥ 2/year Yes, Tophi / chronic gouty arthritis / imaging joint damage Present, Any of nephrolithiasis/CKD/hypertension/diabetes/dyslipidemia/cardio-cerebrovascular disease/onset < 40 yr Present → Result: Urate-lowering therapy Recommend starting ULT（Serum urate: 500 µmol/L, Target urate: < 300 µmol/L (not chronically < 180), Initiation threshold: ≥ 480 → start; ≥ 420 with frequent flares/tophi/nephrolithiasis/CKD/metabolic or cardio-cerebrovascular disease/onset < 40 yr → start）