Urate-Lowering Therapy

This chapter outlines the use of urate-lowering therapies (ULT), which is central to the management of hyperuricemia leading to gout. The goal of ULT use is to reduce or ultimately eliminate the disease burden caused by symptomatic flares, tophi, and progressive joint destruction, which can be achieved by lowering and maintaining serum urate concentrations below 5 to 6 mg/dL using a treat-to-target approach. This chapter first outlines appropriate patient selection, treatment initiation, therapy duration, target serum urate thresholds, and the use of anti-inflammatory prophylaxis, factors that underpin optimal ULT in gout management. This chapter details the currently available classes of ULT medications including xanthine oxidase inhibitors (allopurinol and febuxostat), uricosurics (probenecid, benzbromarone, and sulfinpyrazone), and recombinant uricase (pegloticase). Information highlighted within the discussion of each class of ULT medications includes indications, mechanism of action, pharmacology, dosing and administration information, potential toxicity, fertility/pregnancy/lactation concerns, and drug interactions and contraindications.