Lay summary
Long-term urate lowering is key to successful treatment of gout. However, commencing urate lowering therapies, particularly when starting higher doses, is associated with painful attacks of gout. This has led to the recommendation that patients should receive additional medication to prevent gout attacks for several months when starting urate lowering treatment. The common medications for preventing gout attacks are colchicine, non-steroidal anti-inflammatories or steroids, all of which may have adverse effects. Current recommendations for commencing allopurinol, the most common urate lowering therapy, are to start at low dose and gradually increase over several months. This ‘start-low go slow’ dose strategy may be associated with fewer gout flares and thus negate the need for medication to prevent flares. We will undertake a clinical trial to determine whether medication to prevent gout attacks is required with the new allopurinol dosing strategy and whether the side effects of this medication outweigh the benefits.