Table 2

Recommendations to treat-to-target gout

Overarching principles
AGout is a chronic and serious disease with impaired quality of life and reduced life expectancy that can be treated effectively.9.5±0.9
BReducing and maintaining serum urate below a defined target is mandatory to eliminate urate crystals and improve patient outcomes.9.8±0.7
CSuccessful management of gout requires education about all aspects of the disease and full involvement of the patient in shared decision-making.9.7±0.7
DLong-term adherence to urate-lowering therapy is essential for an optimal outcome.9.4±0.8
1Serum urate must be measured regularly and urate-lowering therapy should be adjusted to attain the therapeutic target.2B9.8±0.6
2A serum urate level <6 mg/dL (<360 µmol/L) should be targeted and maintained in all patients with gout1A9.5±0.9
3In patients with severe gout, such as those with tophi or frequent attacks, the target should be a serum urate level <5 mg/dL (<300 µmol/L) until clinical remission is achieved5D9.2±1.5
4Acute attacks should be treated promptly with anti-inflammatory medications, taking safety issues into consideration5D9.9±0.5
5Prophylaxis against attacks should be initiated and continued for at least 6 months after starting urate-lowering therapy.5D8.3±1.7
6In all patients with gout, renal function should be assessed at the time of diagnosis and then monitored regularly.5D9.6±0.7
7Comorbidities associated with gout may influence therapy and outcomes and should be assessed regularly and managed5D9.5±0.8
8Modifiable risk factors should be addressed primarily through patient education and support.5D9.2±1.5
9Information about gout and its management should be made readily available to patients by their healthcare professionals.5D9.7±0.7
  • SoR on a 0–10 scale with 0=no agreement at all and 10=very strong agreement.

  • GoR, grade of recommendation; LoE, level of evidence; SoR, strength of recommendation.