title: Efficacy and safety of a urate lowering regimen in primary gout.
abstract: OBJECTIVE
  Pharmacologic urate lowering therapy (ULT), at full maintenance doses, has been associated with acute gout arthritis (in up to 80% of patients). The American College of Rheumatology has recently advocated gradually titrating the maintenance dose upward to chosen serum urate target. Few studies have examined the efficacy and safety of a ULT in primary gout.
  
  
  METHODS
  The ULT regimen examined included allopurinol (50 mg/day, with increases of 50 mg/month up to 300 mg/day) and colchicine, as prophylaxis to prevent acute gouty attacks. The efficacy and safety of this regimen was examined in 42 patients in whom allopurinol was withheld for ≥3 months and restarted after this assessment and followed up for 12 months. The efficacy and safety of the ULT regimen was related to the serum urate decrease and to the incidence of acute gout flares, respectively.
  
  
  RESULTS
  Fifty-nine patients (mean age 59 years, 56 men) with primary gout received the gradually titrated ULT regimen. Baseline serum urate was (mean±SD) 8.4±0.8 mg/dL. At 3, 6, 9, and 12 months serum urate fell by a mean of 1.8, 2.5, 2.7, and 2.5 mg/dL, respectively (p<0.001). A serum urate level<6.0 mg/dL was achieved by 38/59 (64%) patients. During the 12 months following the start of the ULT we documented 10 acute arthritis episodes (17% of patients).
  
  
  CONCLUSIONS
  A gradually titrated hypouricemic regimen for 6 months in patients with primary gout appears to be effective and safe.
authors.affiliation: a Division of Internal Medicine, Metabolic-Vascular Unit , La Paz University Hospital , Madrid , Spain.
authors.forename: Rebeca
authors.initials: R
authors.lastname: Bailén
authors.forename: Nicolás M
authors.initials: NM
authors.lastname: González Senac
authors.forename: Mónica M
authors.initials: MM
authors.lastname: López
authors.forename: M Luisa
authors.initials: ML
authors.lastname: Llena
authors.forename: Marta
authors.initials: M
authors.lastname: Migoya
authors.forename: M Teresa
authors.initials: MT
authors.lastname: Rodríguez
authors.forename: Eugenio
authors.initials: E
authors.lastname: de Miguel
authors.forename: Rosa J
authors.initials: RJ
authors.lastname: Torres
authors.forename: Juan G
authors.initials: JG
authors.lastname: Puig
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006073:Gout / Q000097:blood* / Q000188:drug therapy*; D006761:Hospitals; D006801:Humans; D008297:Male; D008875:Middle Aged; D012449:Safety; D014527:Uric Acid / Q000097:blood*
chemical_list: D014527:Uric Acid
keywords: Gout; allopurinol; hyperuricemia