New research presented at the annual Congress of the European Alliance of Associations for Rheumatology (EULAR) suggests that continuing urate-lowering therapy (ULT) remains the most effective strategy for maintaining remission in patients with gout, although some patients may successfully remain symptom-free after discontinuing treatment.
The findings come from a large randomized clinical trial conducted across nine rheumatology centers in the Netherlands, where researchers evaluated whether patients in remission could safely stop urate-lowering therapy or should continue treatment under a treat-to-target approach.
The study included 309 gout patients who had achieved remission. Researchers compared outcomes between patients who continued ULT and those who attempted to discontinue therapy. After 24 months of follow-up, remission rates remained higher among patients who stayed on treatment. Nearly 79% of patients in the continuation group maintained remission compared with about 63% in the discontinuation group.
Patients who continued urate-lowering therapy also experienced significantly fewer gout flares. The cumulative incidence of flare-ups was approximately 12% among those remaining on treatment, compared with nearly 32% in patients who attempted to stop therapy. Researchers also observed a modest benefit in kidney function among participants who continued treatment.
Despite these findings, the study highlighted that a substantial proportion of patients who discontinued therapy remained flare-free throughout the observation period. Nearly one-quarter of patients who stopped treatment eventually restarted ULT after experiencing disease recurrence or other concerns.
Researchers believe the results reinforce current international recommendations supporting long-term urate-lowering therapy for gout management while also providing valuable information for shared decision-making between physicians and patients.
In another study presented at the congress, investigators explored how body fat distribution and muscle composition influence the risk of developing gout and rheumatoid arthritis. Using MRI data from the UK Biobank, researchers found that individuals with gout tended to have higher levels of visceral fat, liver fat, and fat accumulation within muscles compared with healthy controls.
The analysis also revealed that these unfavorable fat distribution patterns were associated with a greater likelihood of developing cardiometabolic conditions such as type 2 diabetes and coronary heart disease. Furthermore, individuals with increased visceral, liver, and muscle fat were found to have a higher risk of developing gout in the future.
For rheumatoid arthritis, researchers identified a different pattern. Greater fat infiltration within muscle tissue combined with lower muscle volume was linked to an increased risk of developing the disease.
The findings underscore the growing importance of lifestyle interventions in rheumatic diseases. Experts emphasized that maintaining a healthy body weight, reducing excess body fat, and improving muscle quality through regular physical activity could play a significant role in both prevention and long-term disease management.
With obesity rates continuing to rise globally, researchers believe a better understanding of body composition may help identify high-risk individuals earlier and support more personalized approaches to preventing gout, rheumatoid arthritis, and their associated complications.
