How to use the new clinical guidelines “Idiopathic gout”: principles of urate-lowering therapy
https://doi.org/10.14412/1996-70122025-6-92-97
Abstract
In 2025, new clinical guidelines on gout – one of the most common rheumatic diseases – were published. This article discusses the main principles of the practical application of the key component of successful gout management: urate-lowering therapy (ULT). Special attention is given to the indications for initiating ULT, the timing of its initiation and duration, and the principles for selecting the optimal target serum uric acid (UA) level. The most rational regimens for prescribing allopurinol and febuxostat are examined, taking into account, in accordance with the guidelines, the clinical manifestations of gout and the presence of comorbidities. Other medicinal agents that affect serum UA levels are also presented.
Supporting agencies: The article was prepared within the framework of the basic research project “Development of approaches to the phenotyping of autoinflammatory degenerative rheumatic diseases based on a comparative study of biochemical, immunological, and genetic factors associated with the state of bone, cartilage, muscle, and adipose tissues”, №. 125020501433-4
About the Authors
M. S. Eliseev
V.A. Nasonova Research Institute of Rheumatology
Russian Federation
Russian Federation
Maksim Sergeevich Eliseev
34A, Kashirskoe shosse, Moscow 115522
Ya. I. Kuzmina
V.A. Nasonova Research Institute of Rheumatology
Russian Federation
Russian Federation
34A, Kashirskoe shosse, Moscow 115522
M. N. Chikina
V.A. Nasonova Research Institute of Rheumatology
Russian Federation
Russian Federation
34A, Kashirskoe shosse, Moscow 115522
References
1. https://cr.minzdrav.gov.ru/view-cr/936_1
2. Richette P, Doherty M, Pascual E, et al. 2016 updated EULAR evidence-based recommendations for the management of gout. Ann Rheum Dis. 2017 Jan;76(1):29-42. doi: 10.1136/annrheumdis-2016-209707.
3. Perez Ruiz F, Richette P, Stack AG, et al. Failure to reach uric acid target of <0.36 mmol/L in hyperuricaemia of gout is associated with elevated total and cardiovascular mortality. RMD Open. 2019 Oct 13;5(2):e001015. doi: 10.1136/rmdopen-2019-001015.
4. Vargas-Santos AB, Neogi T, da Rocha Castelar-Pinheiro G, et al. Cause-Specific Mortality in Gout: Novel Findings of Elevated Risk of Non-Cardiovascular-Related Deaths. Arthritis Rheumatol. 2019 Nov;71(11):19351942. doi: 10.1002/art.41008.
5. Yu KH, Chen DY, Chen JH, et al. Management of gout and hyperuricemia: Multidisciplinary consensus in Taiwan. Int J Rheum Dis. 2018 Apr;21(4):772-787. doi: 10.1111/1756-185X.13266.
6. Conley B, Bunzli S, Bullen J, et al. What are the core recommendations for gout management in first line and specialist care? Systematic review of clinical practice guidelines. BMC Rheumatol. 2023 Jun 15;7(1):15. doi: 10.1186/s41927-023-00335-w.
7. FitzGerald JD, Dalbeth N, Mikuls T, et al. 2020 American College of Rheumatology Guideline for the Management of Gout. Arthritis Care Res (Hoboken). 2020 Jun;72(6): 744-760. doi: 10.1002/acr.24180.
8. Neilson J, Bonnon A, Dickson A, Roddy E; Guideline Committee. Gout: diagnosis and management-summary of NICE guidance. BMJ. 2022 Aug 30;378:o1754. doi: 10.1136/bmj.o1754.
9. Perez-Ruiz F, Calabozo M, Pijoan JI, et al. Effect of urate-lowering therapy on the velocity of size reduction of tophi in chronic gout. Arthritis Rheum. 2002 Aug;47(4):356-60. doi: 10.1002/art.10511.
10. Ellmann H, Bayat S, Araujo E, et al. Effects of Conventional Uric Acid-Lowering Therapy on Monosodium Urate Crystal Deposits. Arthritis Rheumatol. 2020 Jan;72(1): 150-156. doi: 10.1002/art.41063.
11. Pascart T, Grandjean A, Capon B, et al. Monosodium urate burden assessed with dualenergy computed tomography predicts the risk of flares in gout: a 12-month observational study: MSU burden and risk of gout flare. Arthritis Res Ther. 2018 Sep 17;20(1):210. doi: 10.1186/s13075-018-1714-9.
12. Francis-Sedlak M, LaMoreaux B, Padnick-Silver L, et al. Characteristics, Comorbidities, and Potential Consequences of Uncontrolled Gout: An Insurance-Claims Database Study. Rheumatol Ther. 2021 Mar;8(1): 183-197. doi: 10.1007/s40744-020-00260-1.
13. Hershfield MS. Reassessing serum urate targets in the management of refractory gout: can you go too low? Curr Opin Rheumatol. 2009 Mar;21(2):138-42. doi: 10.1097/BOR.0b013e3283257b83.
14. Perez-Ruiz F, Herrero-Beites AM, Carmona L. A two-stage approach to the treatment of hyperuricemia in gout: the "dirty dish" hypothesis. Arthritis Rheum. 2011 Dec; 63(12):4002-6. doi: 10.1002/art.30649.
15. Jia E, Yao X, Geng H, et al. The effect of initiation of urate-lowering treatment during a gout flare on the current episode: a metaanalysis of randomized controlled trials. Adv Rheumatol. 2022 Jan 29;62(1):5. doi: 10.1186/s42358-022-00236-5.
16. Eliseev MS, Chikina MN, Zhelyabina OV. An open 6-month study of the effectiveness of titration of the dose of allopurinol in patients with gout as part of the “treat to target” strategy. Russkii meditsinskii zhurnal. 2022;(6): 17-22. (In Russ.).
17. Cipolletta E, Nakafero G, Rozza D, et al. Development and validation of a prognostic model for predicting the risk of allopurinolinduced severe cutaneous adverse reactions: a retrospective new-user cohort study using linked primary care, hospitalisation, and mortality data. Lancet Rheumatol. 2025 Dec; 7(12):e840-e850. doi: 10.1016/S2665-9913(25)00165-1.
18. Yokose C, Lu N, Xie H, et al. Heart disease and the risk of allopurinol-associated severe cutaneous adverse reactions: a general population-based cohort study. CMAJ. 2019 Sep 30;191(39):E1070-E1077. doi: 10.1503/cmaj.190339.
19. Bathini L, Garg AX, Sontrop JM, et al. Initiation Dose of Allopurinol and the Risk of Severe Cutaneous Reactions in Older Adults With CKD: A Population-Based Cohort Study. Am J Kidney Dis. 2022 Dec;80(6): 730-739. doi: 10.1053/j.ajkd.2022.04.006.
20. Becker MA, Schumacher HR Jr, Wortmann RL, et al. Febuxostat, a novel nonpurine selective inhibitor of xanthine oxidase: a twenty-eight-day, multicenter, phase II, randomized, double-blind, placebo-controlled, dose-response clinical trial examining safety and efficacy in patients with gout. Arthritis Rheum. 2005 Mar;52(3):916-23. doi: 10.1002/art.20935.
21. Ghossan R, Aitisha Tabesh O, Fayad F, et al. Cardiovascular Safety of Febuxostat in Patients With Gout or Hyperuricemia: A Systematic Review of Randomized Controlled Trials. J Clin Rheumatol. 2024 Mar 1;30(2): e46-e53. doi: 10.1097/RHU.0000000000002045.
22. Fan M, Liu J, Zhao B, et al. Comparison of efficacy and safety of urate-lowering therapies for hyperuricemic patients with gout: a meta-analysis of randomized, controlled trials. Clin Rheumatol. 2021 Feb;40(2):683-692. doi: 10.1007/s10067-020-05272-4.
23. Roughley MJ, Belcher J, Mallen CD, Roddy E. Gout and risk of chronic kidney disease and nephrolithiasis: meta-analysis of observational studies. Arthritis Res Ther. 2015 Apr 1;17(1):90. doi: 10.1186/s13075-0150610-9.
24. Sellmayr M, Hernandez Petzsche MR, et al. Only Hyperuricemia with Crystalluria, but not Asymptomatic Hyperuricemia, Drives Progression of Chronic Kidney Disease. J Am Soc Nephrol. 2020 Dec;31(12):2773-2792. doi: 10.1681/ASN.2020040523.
25. Eliseev MS, Kuzmina YaI. Febuxostat in patients with hyperuricemia and gout: is the nephroprotective effect real? Sovremennaya Revmatologiya = Modern Rheumatology Journal. 2024;18(5):135-140. (In Russ.). doi: 10.14412/1996-7012-2024-5-135-140
26. Azad S, Dutta PK, Huda MN, et al. Febuxostat efficiently reduces the progression of chronic kidney disease in asymptomatic hyperuricemia: an interventional study. Egypt J Intern Med. 2025;37:58. doi: 10.1186/s43162025-00446-5.
27. Eliseev MS, Chikina MN, Zhelyabina OV, Kuzmina YaI. The dose of febuxostat required to achieve the target level of uric acid in patients with normal and impaired renal function. Sovremennaya Revmatologiya = Modern Rheumatology Journal. 2025;19(2):92-97. (In Russ.). doi: 10.14412/1996-7012-2025-292-97.
28. Eliseev MS, Zhelyabina OV, Chikina MN, Thakokov MM. Febuxostat efficacy in patients with gout depending on kidney function. Russkii meditsinskii zhurnal. Meditsinskoe obozrenie. 2022;6(3):140-147 (in Russ.).
29. Eliseev MS, Chikina MN, Zhelyabina OV. Efficacy of Febuxostat in Patients with Moderate Renal Impairment: Results of a Pilot Study. Effektivnaya farmakoterapiya. 2024; 20(10): 6-11. (In Russ.).
30. Sutton Burke EM, Kelly TC, Shoales LA, Nagel AK. Angiotensin Receptor Blockers Effect on Serum Uric Acid-A Class Effect? J Pharm Pract. 2020 Dec;33(6):874-881. doi: 10.1177/0897190019866315.
31. Choi HK, Soriano LC, Zhang Y, Rodriguez LA. Antihypertensive drugs and risk of incident gout among patients with hypertension: population based case-control study. BMJ. 2012 Jan 12:344:d8190. doi: 10.1136/bmj.d8190.
32. McAdams DeMarco MA, Maynard JW, Baer AN, et al. Diuretic use, increased serum urate levels, and risk of incident gout in a population-based study of adults with hypertension: the Atherosclerosis Risk in Communities cohort study. Arthritis Rheum. 2012 Jan;64(1): 121-9. doi: 10.1002/art.33315.
33. Zhao Y, Xu L, Tian D, et al. Effects of sodium glucose co transporter 2 (SGLT2) inhibitors on serum uric acid level: A meta analysis of randomized controlled trials. Diabetes Obes Metab. 2018 Feb;20(2):458-462. doi: 10.1111/dom.13101.
34. Derosa G, Maffioli P, Sahebkar A. Plasma uric acid concentrations are reduced by fenofibrate: A systematic review and meta=analysis of randomized placebo-controlled trials. Pharmacol Res. 2015 Dec:102:63-70. doi: 10.1016/j.phrs.2015.09.012.
Review
For citations:
Eliseev MS, Kuzmina YI, Chikina MN. How to use the new clinical guidelines “Idiopathic gout”: principles of urate-lowering therapy. Sovremennaya Revmatologiya=Modern Rheumatology Journal. 2025;19(6):92-97. (In Russ.) https://doi.org/10.14412/1996-70122025-6-92-97
Views:
49
Email this article 