Gout in Norway (NOR-Gout)

Patients are treated in the rheumatology outpatient department as clinically required. The treatment objective is to reduce serum urate to a treatment target below 360 micromol/L, and 300 micromol/L in case of tophi. The treatment approach is in line with the EULAR treatment recommendations for gout. The first drug of choice is allopurinol 100 mg tablets once daylig. The dose will be increased monthly by 100 mg until maximum 900 mg daily is reached or the treatment target is met. In case insufficient effect (i.e. not reaching the treatment target) or adverse events, other approved drugs can be used such as probenecid 500 mg tablets (maximum 1000 mg daily) to increase excretion of uric acid or febuxostat tablets (40 mg to maximum 120 mg daily) as an alternative xanthinoxidase inhibitor. If patients already use urate lowering therapy when included into the study, medication will be increased if necessary to reach the treatment target. All patients who start urate lowering therapy during the study period, will be given flare prophylaxis with anti-inflammatory medication (an NSAID or colchicine orally) for 6 months at the discretion of the treating physician. Adherence to treatment and adverse events are monitored during the frequent visits by physician or nurse (initially every month), inquiring if the patient has taken the prescribed drugs and has experienced adverse events. Serum urate, as a measure of adherence is also checked frequently and initially every month. If serum urate at the baseline visit is only slightly increased (360-420µmol/l), diet and life-style advice during the first month can be given alone, to see if these measure are sufficient to reduce serum urate to target until the next study visit. Study visits are initially monthly and monitor adherence to therapy, laboratory tests for serum urate, liver and kidney function as well as adverse events, When the treatment target of 360µmol/l is reached, existing medication is maintained at the present dose and fixed visits are schedules at 3, 6, 12 and 24 months.