If ULTs are introduced for long-term use, doses should be titrated based on monthly serum urate levels aiming for below 360 micromol/litre (5mg/dl). For people with tophi, chronic gouty arthritis, or who continue to experience flares at this level, the recommended target level is no more than 300 micromol/litre (5mg/dl).[1]

First line treatments allopurinol or febuxostat should be started at least 2-4 weeks after a gout flare has settled. Allopurinol is preferred in major cardiovascular disease. Colchicine may be added while reaching the target serum urate level, or use low-dose NSAID or a low-dose corticosteroid (with a PPI if necessary).[1,14]

An IL-1 inhibitor such as canakinumab should be initiated by the rheumatology service when other medicines are not suitable.[1]