Gout articles from across Nature Portfolio

In this Review, the authors provide an overview of the therapeutic effects of uricases, outcomes related to gout and its comorbidities in clinical trials and challenges surrounding the use of uricases as potent urate-lowering therapy for the treatment of gout.

The potential association between neurodegenerative disease risk and gout is not fully understood. Here the authors showed that gout is causally related to several measures of brain structure which may explain their higher vulnerability to dementia.

Gout can be effectively treated with long-term urate-lowering therapy. Current guidelines advocate the use of a treat-to-target serum urate strategy, with a target serum urate concentration of <5 mg/dl (<0.30 mmol/l) or <6 mg/dl (<0.36 mmol/l), but specific targets are under debate. In this Review, the authors consider the rationale and evidence for the recommendations.

The paradoxical increase in gout flare risk upon initiation of urate-lowering therapy presents challenges for the measurement and analysis of gout flares in clinical trials of urate-lowering therapy. In this Perspective, the authors highlight these issues and discuss potential solutions.

Often viewed as merely an inconsequential episode of acute joint pain, gout flare has also been associated with an increased risk of acute myocardial infarction and stroke. New findings suggest the risk is highest within the first 60 days of gout flare, and could be influenced by flare treatment.

An important question for patients and providers is whether and to what extent dietary interventions, diet supplements or weight loss can help to prevent incident gout or manage existing gout. Evidence is emerging, but randomized trials are still needed to fill this important knowledge gap.