Abstract
For people with gout, the most important aspect of the disease is the gout flare. Thus, a key focus in the management of gout should be the prevention of gout flares. Clinical trial design and researcher focus on serum urate (SU) reduction to a pre-defined target has been driven by the scientific understanding that reducing SU below the point of saturation will lead to dissolution of monosodium urate (MSU) crystals and thus remove the trigger for the flare, in other words SU has been used as a surrogate marker for gout flares. For this reason, SU has been the primary endpoint for clinical trials of urate-lowering therapy (ULT) in the modern era. The focus on SU in clinical trials without sufficient consideration of gout flares and their impact leaves clinicians with many unanswered questions about management of gout. Herein we discuss the importance of the gout flare and the rationale for changing our thinking to include a greater focus on the gout flare as a clinical trial outcome, and what this might mean for gout management and research.