Uricaemia as a surrogate endpoint in gout trials and the treat-to-target approach for gout management

Gout is believed to be the best understood and treatable type of inflammatory arthritis. Monosodium urate crystals that deposit as a result of long-term hyperuricaemia are pathogenic and cause flares, tophi, and bone erosion. Flares are the most frequent and disabling manifestation of gout and are thought to be triggered by monosodium urate crystals moving from their site of deposition on cartilage into the joint space, allowing interaction with cells of the synovial lining and activation of the NLRP3 inflammasome. 1 Martinon F Pétrilli V Mayor A Tardivel A Tschopp J Gout-associated uric acid crystals activate the NALP3 inflammasome. Nature. 2006; 440: 237-241 Crossref PubMed Scopus (3562) Google Scholar Association between serum urate and flares in people with gout and evidence for surrogate status: a secondary analysis of two randomised controlled trialsAchieving an average serum urate concentration less than 6 mg/dL is associated with an absence of gout flares and a reduction in the number of flares in the subsequent 12 months in people with gout. These results support a treat-to-target serum urate approach in the management of gout. Full-Text PDF