🦶 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.
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)
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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.
Worked calculation
The values below come from this tool's own example placeholders and are computed server-side with the formula shown on this page, so the arithmetic can be checked quickly. It demonstrates how to substitute values only — it is not clinical advice and not a real case.
| 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 |
→Urate-lowering therapyRecommend 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
Frequently asked questions
- What is 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.
- How is Gout Urate-Lowering Therapy: Indications & Targets calculated? What is the core formula?
- 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.
- When is Gout Urate-Lowering Therapy: Indications & Targets used?
- 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).
- What are the key clinical points for Gout Urate-Lowering Therapy: Indications & Targets?
- 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.
- What are the limits and cautions when using Gout Urate-Lowering Therapy: Indications & Targets?
- 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.
- How is Gout Urate-Lowering Therapy: Indications & Targets calculated in practice? Can you show a worked example?
- 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）