Strategie studie over urinezuurverlagende therapie bij jicht. Levenslang doorgaan of is (tijdelijk) stoppen mogelijk?

Urate lowering therapies (ULT) are used in patients with gout to lower serum urate (SU) levels to prevent crystal depositions which can result in inflammation. Rheumatology guidelines recommend the use of ULT by the so-called treat-to-target strategy (T2T); SU levels should be <0.36 mmol/l or <0.30 mmol/l in severe gout, by increasing or combining ULT until the target has been reached. Due to the chronicity of gout, the high safety and low costs of ULT, most experts therefore advise to use ULT lifelong. However, a different, frequently used method (mainly by patients themselves or general practitioners, GPs) is a treat-to-symptom strategy (T2S), which only aims at a patient acceptable symptom state, regardless of SU levels. ULT are often stopped when in remission and are restarted when gout flares reoccur (too often). Although most rheumatologists strongly belief that the T2T approach is superior to T2S, high quality evidence to support either of the strategies is lacking, both in the induction phase but especially in the maintenance phase. We hypothesize that the T2T strategy is superior compared to the T2S in retaining gout remission and is also more cost-effective.

We hypothesize that the T2T strategy is superior compared to the T2S in retaining gout remission and is also more cost-effective.

Visits: baseline, 2 weeks after ULT cessation, month 12, month 24 Questionnaires: flare monitoring monthly, other PROMs and medical costs three monthly

Continuation or tapering to stop of urate lowering therapy