Treat-to-Target Serum Urate Versus Treat-to-Avoid Symptoms in Gout

"For the TTT-SU group: The dose titration algorithm for allopurinol increases every 4 weeks by 100 mg until the target serum urate of 6 mg/dL is reached or a patient requires 800 mg per day of allopurinol. Subjects will require a blood draw for SU every 4 weeks until reaching the target.~For the TTASx group: Subjects randomized to the TTASx group will receive anti-inflammatory treatments (naproxen, colchicine, and/or prednisone) for up to six flares over the ensuing three months. Urate lowering therapy (ULT) will only be offered after the third flare during the trial."

Naproxen 250 mg p.o. twice daily

Colchicine 0.6 mg p.o. once daily

Dose escalation to 0.6 mg p.o. twice daily for patients experiencing breakthrough flares or a dose decrease (0.6 mg p.o. every other day) for patients experiencing gastrointestinal intolerance.

dose escalation to 500 mg twice daily for patients experiencing breakthrough flares.

For flare glucocorticoids: prednisone taper for 8 days, starting with 40mg (oral) daily.