Compared with placebo, urate-lowering therapy with once-daily febuxostat at 40mg (or 80mg if serum uric acid was ≥6 mg/dL after 14 days) in patients with early gout (hyperuricaemia and ≤2 gout flares; n = 183) reduced MRI-detected synovitis (change from baseline RAMRIS score of −0.43 versus −0.07; P < 0.001), decreased the incidence of disease flares (29.3% versus 41.4%; P < 0.05) and increased the proportion of patients obtaining a serum uric acid level of <6 mg/dL (62.8% versus 5.7%; P < 0.001) after 24 months. However, treatment with febuxostat did not cause detectable changes in joint erosion over 2 years.