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A retrospective analysis examined whether it's better to initiate urate-lowering therapy (ULT) during or after an attack of acute gout.
Patients on ULT for > 3yrs were divided into 2 groups: 1) group 1 included 123 patients who started ULT during an acute attack of gout; and 2) group 2 included 457 patients who were given ULT after an acute attack. Both groups had similar mean serum urate levels at the start (7.8±1.4mg/dL vs. 7.9±1.9mg/dL, respectively) and both equally achieved a uric acid target level of <6.0mg/dL (66.7 and 65.6%, respectively).
The time to achieve target SUA levels was shorter in group 1 than in group 2, but the number of flares were higher in group 1 compared to those in group 2. Chronic kidney disease was lower in group 1 than in group 2. Although initiation of ULT during the acute gouty attack decreased the time required to reach the target urate levels and the incidence of chronic kidney disease, but the attack rate was greater in the first 12 weeks.