Gout Flares Spike After Stopping Anti-Inflammatory Prophylaxis
A new rapid literature review and meta-analysis in Arthritis Care & Research reports that gout flares significantly increase in the 3 months after stopping anti-inflammatory prophylaxis in patients initiating urate-lowering therapy (ULT).
Study Findings
Investigators conducted a rapid literature review and random-effects meta-analysis of studies reporting gout flares during and after anti-inflammatory prophylaxis in adults beginning or escalating ULT. The pooled analysis included 6 trials plus unpublished aggregated data from the VA STOP Gout trial, with a combined sample that included 2972 participants in the latter.
During prophylaxis, an estimated 14.7% of participants experienced at least one gout flare (95% CI, 11.3%–18.5%). In contrast, within 3 months of stopping prophylaxis, the flare rate doubled to 29.7% (95% CI, 22.9%–37.0%). By the last follow-up period, flare incidence declined to 12.2% (95% CI, 6.8%–19.0%). The mean difference in flare incidence between the prophylaxis and immediate post-cessation period was −14.8% (95% CI, −21.2% to −8.5%; P < .0001). Sensitivity analyses showed that variations in prophylaxis duration, ULT class, or inclusion of placebo arms did not materially impact results.
The investigators emphasize that “gout flares are common after stopping anti-inflammatory prophylaxis but return to levels seen during prophylaxis,” signaling a transient but clinically meaningful risk window.
Clinical Implications
The analysis underscores that the protective effect of prophylaxis is temporary and that patients face a nearly 2-fold rise in flares in the 3 months after stopping medications like low-dose colchicine, NSAIDs, or corticosteroids. Clinicians should counsel patients about this flare risk and proactively plan for effective management, including rapid access to anti-inflammatory treatment strategies, the authors advise.
In practice, this may include extended patient education about symptom recognition, flare-action plans, and individualized decisions on the duration of prophylaxis balanced against potential medication side effects. Recognizing the risk period can help avoid unnecessary morbidity and healthcare utilization from gout flares.
Gout flares frequently surge in the 3 months following cessation of anti-inflammatory prophylaxis when initiating ULT but tend to resolve toward baseline rates thereafter.
Reference:
Stamp LK, Frampton C, Newcomb JA, O’Dell JR, Mikuls TR, Dalbeth N. Gout flares after stopping anti-inflammatory prophylaxis: a rapid literature review and meta-analysis. Arthritis Care Res (Hoboken). 2025; 77(6): 720-726. doi:10.1002/acr.25486.
