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A Metabolomic Signature Predicts Gout Flare Clinical Outcome Associated With Colchicine Prophylaxis.
Wenyan Sun1,2, Lingfang Xu2, Haibing Chen3
1Xiang'an Hospital of Xiamen University, Xiamen, China.
Arthritis & Rheumatology (Hoboken, N.J.)
|February 19, 2026
Summary
Serum metabolomics can predict gout flare risk in patients starting ULT and colchicine. This helps personalize gout flare prophylaxis, optimizing treatment decisions for better outcomes.
Area of Science:
- Rheumatology
- Metabolomics
- Personalized Medicine
Background:
- Gout management involves urate-lowering therapy (ULT) and often colchicine prophylaxis.
- Predicting response to colchicine prophylaxis is crucial for optimizing gout treatment.
Purpose of the Study:
- To investigate serum metabolomics as a biomarker for colchicine prophylaxis responsiveness in gout patients initiating ULT.
- To identify metabolomic signatures associated with gout flares during ULT.
Main Methods:
- A multicenter prospective cohort of 409 patients initiating treat-to-target ULT and colchicine prophylaxis was studied.
- Untargeted metabolomics were performed at enrollment.
- Cox regression and machine learning models analyzed metabolomic data in relation to flare activity.
Main Results:
- 36.9% of participants experienced at least one gout flare.
- Inflammation-related metabolites were differentially abundant in patients with recurrent flares.
- A four-metabolite risk score significantly predicted gout flare activity (aHR 3.21).
- A machine learning model achieved an AUC of 0.771 for flare risk prediction.
Conclusions:
- Metabolomic profiles indicating inflammation status are associated with gout flare outcomes.
- Novel metabolomic signatures identified before ULT initiation can aid in optimizing colchicine prophylaxis decisions.
- This approach may personalize gout flare prevention strategies.
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