Urate-lowering therapy (ULT) is the part of gout treatment designed to change the underlying disease, not simply relieve pain during a flare. The goal is to keep serum urate low enough for existing monosodium urate crystals to dissolve and to prevent new crystals from forming.
Who may need urate-lowering therapy?
Guidelines differ slightly in how strongly they recommend starting treatment after a first flare, but there is broad agreement that ULT is especially important for people with recurrent or troublesome flares, tophi, chronic gouty arthritis, kidney disease or other complications.
What is treat-to-target care?
Treat-to-target means adjusting therapy based on repeated serum urate measurements rather than prescribing a fixed dose and assuming it is enough. If you are following urate between visits, our home uric-acid testing guide explains what home meters can and cannot tell you, and the uric-acid tracking guide can help you bring a useful trend to your healthcare provider. NICE recommends a target below 6 mg/dL (360 micromol/L), and a lower target below 5 mg/dL (300 micromol/L) can be considered for people with tophi, chronic gouty arthritis or persistent frequent flares. The American College of Rheumatology also recommends a serum urate target below 6 mg/dL.
Allopurinol
Allopurinol reduces uric acid production and is widely used as first-line long-term therapy. Dosing is usually started low and increased as needed to reach the serum urate target, taking kidney function and other clinical factors into account. It is not a painkiller and does not stop an acute attack immediately.
Febuxostat
Febuxostat also lowers urate by reducing uric acid production. It can be used when appropriate based on a person’s medical history, tolerance and cardiovascular considerations. Local prescribing guidance varies by country.
Why can flares happen after starting ULT?
As crystal deposits begin to change, gout flares can temporarily become more likely. This does not mean treatment is failing. Guidelines commonly recommend temporary flare-prevention therapy, such as colchicine or another anti-inflammatory option when appropriate, while urate is being lowered.
Should ULT be stopped during a flare?
People already taking prescribed urate-lowering therapy are generally advised to continue it during a flare unless their clinician tells them otherwise. Stopping and restarting can destabilize urate levels.
How long is treatment needed?
Gout is usually a lifelong tendency. NICE describes ULT as typically long-term and often lifelong once indicated. Australian rheumatology resources make the same practical point: lowering urate consistently is what allows crystals to gradually dissolve and prevents recurrence.
Treatment decisions and drug availability differ across the United States, United Kingdom, Australia, Kenya and other countries, so the exact regimen should be individualized locally.
This article is educational and is not a substitute for individualized medical advice.
Sources
- American College of Rheumatology: 2020 Gout Guideline
- NICE NG219: Gout—diagnosis and management
- Australian Rheumatology Association: Allopurinol
- Australian Rheumatology Association: Febuxostat
Evidence checked September 2026.