Optimal Range of Serum Urate Concentrations to Minimize Risk of Gouty Attacks During Anti-Hyperuricemic Treatment

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Abstract
To find an optimal range of urate concentrations wherein the risk of attacks during the initial 6 months of treatment is minimized, data from 350 gouty patients treated with antihyperuricemic drugs were retrospectively analyzed. We determined the optimal range of urate concentrations to be 4.6–6.6 mg/dl. If urate concentrations were within this range, the risk ratio of an attack as opposed to outside of the range was 0.705 (95% confidence interval, 0.629–0.791). The increase (or decrease) in urate concentration in one month associated with minimal risk of gouty attacks was also determined. The lowest risk ratio of attack (0.451) occurred at a range of −0.1 to 0.6 mg/dl/month increase in urate concentrations (95% confidence interval, 0.310–0.655). In conclusion, we propose that urate concentrations during the initial 6 months of antihyperuricemic therapy should be maintained within a range of 4.6–6.6 mg/dl, and reduction in the urate concentrations during treatment should be as slow as possible.

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