Abstract:Objective To evaluate the efficacy and safety of immediate versus delayed (2-week) initiation of urate-lowering therapy (ULT) combined with anti-inflammatory treatment during acute gout attacks, and to explore the effects of early ULT strategy on serum uric acid control, gout recurrence, and joint symptom improvement.Methods Between February 2025 and February 2026, 68 patients with acute gout admitted to Puyang Oilfield General Hospital were randomly divided into group A and group B using a random number table method, with 34 cases in each group. Both groups received the same anti-inflammatory regimen during the acute phase. On this basis, group A initiated ULT immediately upon admission (febuxostat 40 mg/d); group B initiated the same ULT regimen 2 weeks after resolution of acute symptoms. The two groups were compared in terms of serum uric acid target achievement rate at 4 weeks of treatment, gout recurrence rate within 4 weeks, joint pain [visual analogue scale (VAS) ], joint swelling (joint swelling score), inflammatory markers [high-sensitivity C-reactive protein (hs-CRP), erythrocyte sedimentation rate (ESR), tumor necrosis factor-alpha (TNF-α), interleukin-6 (IL-6), IL-1β], renal function [serum creatinine (Scr), estimated glomerular filtration rate (eGFR) ], liver function [alanine aminotransferase (ALT), aspartate aminotransferase (AST) ], and the incidence of adverse drug reactions within 4 weeks.Results After 4 weeks of treatment, the serum uric acid target achievement rate in group A was significantly higher than that in group B (P < 0.05). No statistically significant difference was observed in the gout recurrence rate between the two groups at 4 weeks (P > 0.05). Regarding VAS pain scores, there were statistically significant differences across different time points (baseline, day 3, day 7, week 2, and week 4) within both groups (P < 0.05). However, no statistically significant differences were found between the two groups in VAS scores at any time point, nor in the trend of changes over time (P > 0.05 for both). For joint swelling scores, no statistically significant differences were observed between the two groups at either baseline or day 7 (P > 0.05). Within each group, the joint swelling scores at day 7 were significantly lower than those at baseline (P < 0.05). Regarding inflammatory markers (hs-CRP, ESR, TNF-α, IL-6, and IL-1β), there were statistically significant differences across different time points (baseline, day 7, week 2, and week 4) within both groups (P < 0.05). However, no statistically significant differences were found between the two groups in any of these markers at any time point, nor in the trends of changes over time (P > 0.05 for all). For renal function (Scr, eGFR) and liver function (ALT, AST) parameters, no statistically significant differences were observed in time effects, between-group effects, or their interaction effects (P > 0.05 for all). The overall incidence of adverse reactions showed no statistically significant difference between the two groups (P > 0.05).Conclusion On the basis of adequate anti-inflammatory therapy, immediate initiation of ULT during acute gout attacks can significantly improve the serum uric acid target achievement rate at 4 weeks of treatment, does not increase the short-term recurrence rate, does not aggravate pain, joint swelling, or inflammatory response, without compromising hepatic or renal safety. This strategy has good efficacy and safety and may serve as an optimized option for ULT in patients with acute gout.
