TOPLINE:

A majority of patients receiving 5 years of treat-to-target urate-lowering therapy maintained target serum uric acid levels and continued to show decreases in signs of crystal deposits and tophi. Only 16% experienced flares in the final year, all of whom had higher serum uric acid levels and increased crystal depositions.

METHODOLOGY:

• Researchers conducted a prospective, single-center, observational study to examine whether maintaining low serum uric acid levels with treat-to-target urate-lowering therapy leads to progressive reductions in ultrasound-detected crystal deposition, complete dissolution of deposits, and fewer disease flares.
• They enrolled 209 patients (mean age, 56.4 years) with primary gout who had experienced a flare within the previous month and had serum uric acid levels above 360 μmol/L (6 mg/dL); all patients were started on treat-to-target urate-lowering therapy.
• The patients were followed up for 5 years, with visits at baseline and 1, 2, and 5 years.
• At each visit, serum uric acid levels were measured, ultrasound examinations for crystal depositions were performed, clinical examinations for tophi were conducted, and the number of previous gout flares was documented.

TAKEAWAY:

• Serum uric acid levels decreased significantly from 500 μmol/L at baseline to 337 μmol/L at 5 years (P < .001), with 71.2% of patients maintaining levels below 360 μmol/L at the final visit.
• Ultrasound examinations revealed significant reductions in all types of crystal depositions (P < .001), with complete dissolution of double contour in 83.4% and tophi in 63.2% of patients.
• The percentage of patients experiencing gout flares dramatically decreased from 100% at baseline to only 16% at 5 years; those who experienced flares had higher mean serum uric acid levels (394 μmol/L vs 326 μmol/L; P = .005) and increased crystal depositions (P = .006 to .035) than those without flares.

IN PRACTICE:

“Our findings support that the major goal in the treatment of patients with gout is a low sUA [serum uric acid] to avoid crystal depositions and thus eliminate flares,” the authors wrote.

SOURCE:

This study was led by Hilde Berner Hammer, MD, PhD, Diakonhjemmet Hospital in Oslo, Norway. It was published online on November 20, 2025, in Annals of the Rheumatic Diseases.

LIMITATIONS:

This was a single-center study, which may limit the generalizability of the results. Additionally, the ultrasound scoring was performed in real time, with sonographers not blinded to the sequence in time. The recording of flares was based on patient recall over the previous year.

DISCLOSURES:

This study did not receive external funding. Some authors reported receiving personal fees from certain pharmaceutical companies.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.