🦶 Gout Urate-Lowering Therapy: Indications & Targets
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.
Gout Urate-Lowering Therapy: Indications & Targets
Serum urate (µmol/L)
Gout flares ≥ 2/year
Tophi / chronic gouty arthritis / imaging joint damage
Any of nephrolithiasis/CKD/hypertension/diabetes/dyslipidemia/cardio-cerebrovascular disease/onset < 40 yr
When to use
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).
How it works
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.
Key points
- 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.
References
- Chinese Society of Endocrinology. Guideline for the diagnosis and treatment of hyperuricemia and gout (2019).
- FitzGerald JD, et al. 2020 American College of Rheumatology Guideline for the Management of Gout. Arthritis Care Res 2020.
Decision support for licensed clinicians only; not a substitute for clinical judgement, diagnosis or local protocols.