Maintenance treatment with urate-lowering therapy is indicated according to the latest EULAR guidelines (2016) in case of :

• The diagnosis of gout (after the first flare-up).
• Asymptomatic hyperuricemia > 8.0 mg/dL in case of co-morbidity (renal insufficiency, arterial hypertension, ischemic heart disease or heart failure).

Therapy:

• Allopurinol is the standard therapy (note: dose to be reduced in case of renal insufficiency).
• Febuxostat is the second-line therapy if hyperuricemia is insufficiently controlled despite allopurinol. Initially there was doubt about the cardiovascular safety of febuxostat (CARES study), but the more recent FAST study showed non-inferiority and therefore the cardiovascular safety is comparable to allopurinol.
• Combination with azathioprine (Imuran) is contraindicated.
• Colchicine 0.5 mg once a day is best used to prevent a gout flare-up during the first 8 weeks.

Target :

• Uric acid < 6 mg/dl.