Urate-lowering therapy for the prevention and treatment of gout flare

Gout is one of the most common rheumatologic arthritic diseases in the United States. Preventing future gout attacks requires lowering serum urate levels to promote dissolution of urate crystals, which is accomplished by reducing the production of serum uric acid or promoting its excretion. Xanthene oxidase inhibitors (XOIs), including allopurinol and febuxostat, are first-line agents for the prevention of acute attacks. Probenecid, a uricosuric agent, is an appropriate adjunctive therapy or second-line agent when XOIs are contraindicated or poorly tolerated. Recently, several third-line agents (e.g., pegloticase, lesinurad) have become available for the treatment of refractory gout.