From the Guidelines
Approximately 10% of patients with high uric acid will experience gout flares, as supported by high-strength evidence from a systematic review published in the Annals of Internal Medicine in 2017 1. The relationship between serum urate levels and the risk of acute gout attacks has been well-documented, with lower serum urate levels associated with a lower rate of acute gout attacks.
- Key factors influencing the development of gout in patients with hyperuricemia include the degree and duration of hyperuricemia, genetics, diet, alcohol consumption, certain medications, and comorbidities like obesity, hypertension, and kidney disease.
- A post hoc analysis of data from three large trials (ULT, FACT, and APEX) found that patients who achieved a serum urate level less than 357 µmol/L (<6.0 mg/dL) at the end of 1 year had a risk for acute gout attacks of approximately 5%, whereas patients with levels at or above 357 µmol/L (≥6.0 mg/dL) had risks of about 10% to 15% 1.
- Lifestyle modifications such as weight management, limiting alcohol and purine-rich foods, and staying hydrated can help reduce the risk of developing gout in patients with asymptomatic hyperuricemia.
- Treatment is generally not recommended for patients with asymptomatic hyperuricemia unless uric acid levels are extremely high, as the focus is on managing symptoms and preventing complications in those who have developed gout.
From the FDA Drug Label
Data upon which the following estimates of incidence of adverse reactions are made are derived from experiences reported in the literature, unpublished clinical trials and voluntary reports since marketing of allopurinol tablets began Past experience suggested that the most frequent event following the initiation of allopurinol treatment was an increase in acute attacks of gout (average 6% in early studies). An analysis of current usage suggests that the incidence of acute gouty attacks has diminished to less than 1%
The question of whether 10% of patients with high uric acid will or will not have a gout flare is not directly addressed in the provided drug label. The label mentions the incidence of acute gouty attacks in patients treated with allopurinol, but it does not provide information on the percentage of patients with high uric acid who will experience a gout flare. Therefore, no conclusion can be drawn regarding the specific question of 10% of patients with high uric acid having a gout flare 2.
From the Research
Gout Flare and High Uric Acid
- The relationship between high uric acid levels and gout flare is complex, with multiple factors at play 3, 4.
- Studies have shown that higher serum uric acid (SUA) levels are associated with an increased risk of incident and recurrent gout in a graded manner 3.
- However, not all individuals with hyperuricemia will develop gout, and some patients with gout can have normal uric acid levels 4.
- The presence of monosodium urate (MSU) crystals is a key factor in the development of gout, but other elements such as antioxidant properties and inflammatory promoters also play a role 4.
Treatment and Management
- Urate-lowering therapies aim to prevent gout flares by reducing SUA levels, with a focus on treat-to-target strategy 5, 6.
- Standard pharmacotherapies for gout flares include colchicine, NSAIDs, and oral or intramuscular corticosteroids, with IL-1 inhibitors as an option for flare refractory to standard therapies 5.
- Emerging therapies are being developed to improve gout management, including new urate-lowering therapies and anti-inflammatory agents 5, 6.
Risk Factors and Associations
- Hyperuricemia is associated with an increased risk of cardiovascular, metabolic, and renal disease, highlighting the importance of assessing and managing high uric acid levels beyond just gout 7.
- Certain drugs that reduce cardiovascular risk also decrease SUA levels, further improving vascular risk 7.