Early urate-lowering therapy in gouty arthritis with acute flares: a double-blind placebo controlled clinical trial

Background: Gouty arthritis (GA) is a chronic systemic disease with recurrent acute monoarthritis. In a previous study, a higher incidence of acute flares was observed during the initial marked decrease in serum urate level. Our study evaluated the effect of early urate-lowering therapy in patients with acute GA flares. Methods This study included 40 patients with acute GA; of them, 20 received colchicine 0.5 mg colchicine twice daily, while 20 received probenecid 500 mg and colchicine 0.5 mg twice daily. We evaluated GA severity and laboratory data for two weeks after the initial therapy. Results Rapidly decreasing serum uric acid levels was found in the patients treated with probenecid and colchicine compared with the patients treated with colchicine alone on day 8 (-1.77 ± 2.037 vs 1.24 ± 2.084; P < 0.0001). However, the mean decrease in visual analog scale score did not differ significantly between the two groups (-5.20 ± 3.09 vs -3.63 ± 2.38; P = 0.079). Conclusion No significant increase was noted in acute gout flare severity or duration among GA patients treated with early aggressive control of hyperuricemia using probenecid plus colchicine.