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Ann Rheum Dis doi:10.1136/annrheumdis-2012-202594
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Gout treatment: should we aim for rapid crystal dissolution?

  1. Paloma Vela1,2
  1. 1Sección de Reumatología, Hospital General Universitario de Alicante, Alicante, Spain
  2. 2Departamento de Medicina Clínica, Universidad Miguel Hernández de Elche, Alicante, Spain
  1. Correspondence to Professor Eliseo Pascual, Sección de Reumatología, Hospital General Universitario de Alicante, Universidad Miguel Hernández, Av. Pintor Baeza 12, Alicante 03010, Spain; pascual_eli{at}gva.es
  • Received 30 August 2012
  • Revised 2 November 2012
  • Accepted 2 December 2012
  • Published Online First 15 January 2013

Abstract

Monosodium urate crystal deposition in gout precedes the first attack and, while hyperuricaemia persists, it grows and expands to other sites. Fortunately, it is reversible and slowly dissolves when serum uric acid (SUA) is lowered below its saturation point of about 6.8 mg/dl and with certainty below 6 mg/dl. Crystals finally disappear from joints, taking longer in those patients with longer disease duration, probably because of a larger accumulated load of crystals. The SUA level achieved affects the velocity of crystal dissolution and tophi reduction. Accordingly, by deciding the SUA level cut-off point to be achieved by treatment we are determining the time of crystal disappearance and cure of gout. 6 mg/dl is the usual target level, but lower levels appear appropriate to us, particularly in certain situations.

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