What is the target serum urate when treating tophaceous gout with Pegloticase?

• A. Reduce serum urate to 5 mg/dL
• B. Reduce serum urate to 6 mg/dL
• C. Reduce serum urate to 4 mg/dL
• D. Reduce serum urate to 7 mg/dL

Answer: (A)

The target is to maintain serum urate at 5 mg/dL when treating tophaceous gout with Pegloticase. Pegloticase lowers uric acid by converting it to allantoin, and keeping levels at or below 5 mg/dL promotes dissolution of tophi and reduces new crystal formation. Although a general goal in gout management can be below 6 mg/dL, the therapy for tophaceous disease with Pegloticase aims for a tighter target to maximize tophus resolution. Levels at 6 mg/dL or higher won’t drive tophi dissolution as effectively, while going much lower than 5 mg/dL isn’t necessary, and 7 mg/dL is definitely above the desired target.