Global experts outline path to long-term remission and cure in gout

Gout, the most common inflammatory arthritis worldwide, is a curable condition, yet the majority of patients remain undermanaged. In a new expert review, researchers argue that the treatment goal must evolve from controlling acute attacks to achieving long-term remission, and they provide a clear roadmap to reach this target.

The article, published in the journal Rheumatology & Autoimmunity, synthesizes the latest evidence to define gout remission, identify the multifaceted triggers that can derail it, and propose integrated management strategies for sustained disease control.

“Gout is now recognized as a curable disease, but achieving this cure requires a fundamental shift in strategy from both clinicians and patients,” said Professor Zhanguo Li of Peking University, a co-author of the review. “Our work consolidates the ‘how-to’ for reaching and maintaining remission.”

The Challenge: Why Gout Flares Persist

A core message of the review is that preventable gout flares are often triggered by a complex interplay of factors beyond just high serum uric acid (SUA) levels. The authors highlight several key challenges, including: elevated SUA levels, which directly drive crystal formation and inflammation; the initiation, titration, or withdrawal of urate-lowering therapy (ULT); the discontinuation of prophylactic medications like colchicine; dietary and medication triggers such as alcohol and diuretics; the presence of comorbidities like hypertension and obesity; physiological stress during the post-operative period; environmental factors like day-to-day temperature changes; and insufficient knowledge of the disease among both patients and clinicians, leading to poor adherence.

A Simplified Goal: Defining Gout Remission

To make remission a practical goal in clinics, the review highlights simplified criteria: no tophi, no flares for 12 months, and SUA consistently below 6 mg/dL. For patients, remission translates to a life free from symptoms, dietary anxiety, and the mental burden of the disease.

The Path Forward: Integrated Management Strategies

The authors advocate for a cohesive “treat-to-target” strategy, centered on long-term ULT and patient education. Key recommendations include:

Individualized ULT: Setting SUA targets (<6 mg/dL for most, <5 mg/dL for severe cases) and using drugs like allopurinol with gradual dose escalation.

Proactive Flare Prevention: Using colchicine when starting ULT to prevent early flares.

"Treat-to-Dissolve": Using imaging to show patients visual proof of crystal dissolution, enhancing motivation and adherence.

Shared Decision-Making: Collaborating with patients on long-term management plans, including the potential cardiovascular benefits of low-dose colchicine.

“The integration of ‘treat-to-target’ and ‘treat-to-dissolve’ strategies provides a powerful framework,” said Professor Patapong Towiwat of Naresuan University, the review’s first author. “By mastering simplified remission criteria and addressing the diverse triggers, clinicians can now confidently guide their patients toward a cure.”

The review concludes that future work should focus on refining remission standards and confirming the role of colchicine in cardiovascular protection, ultimately improving the quality of life for millions living with gout.