What Is the Evidence for Treat-to-Target Serum Urate in Gout?

  • David Bursill
  • Nicola Dalbeth
Crystal Arthritis (L Stamp, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Crystal Arthritis


Purpose of Review

Most current clinical guidelines for gout management advocate a treat-to-target serum urate approach, although notable differences exist. Serum urate is a rational target for gout treatment given the central role of urate in disease causality, its association with key outcomes and its practicality of use in clinical practice. This review analyses the evidence for this strategy in gout.

Recent Findings

Recent studies have confirmed the efficacy of urate-lowering therapy in achieving serum urate targets, both in trials using fixed doses and those applying a treat-to-target strategy. In a limited number of long-term studies (> 12-month duration), interventions that incorporate a treat-to-target serum urate approach have been shown to promote regression of tophi, reduce the frequency of gout flares and improve MRI-detected synovitis.


A strong case can be made for a treat-to-target serum urate strategy in gout, supported by existing knowledge of disease pathophysiology, outcomes from urate-lowering therapy studies and emerging results of randomised strategy trials of sufficient duration.


Gout Urate Treat to target Urate-lowering therapy 


Compliance With Ethical Standards

Conflict of Interest

Dr. Dalbeth reports grants and personal fees from Ardea/AstraZeneca, personal fees from Takeda, personal fees from Horizon, personal fees from Cymabay, personal fees from Pfizer, personal fees from Abbvie, personal fees from Janssen, grants from Amgen, outside the submitted work.

Dr. Bursill has nothing to disclose.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Bone and Joint Research Group, Department of Medicine, Faculty of Medical and Health SciencesUniversity of AucklandAucklandNew Zealand

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