A recent meta-analysis depicted that at the initial stage of an acute gout attack, it is beneficial to use uric-acid-lowering drugs since it may not aggravate pain. It can lower levels of serum uric acid and also improves patient compliance with medication. However, this is supported by moderate-quality evidence and thus there is a requisition of a larger sample size to validate the results.

Gout, a common chronic disease, has a high rate of recurrence. The best time for using ULT during an acute gout attack remains unclear. A meta-analysis based on PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analysis) guidelines was conducted to investigate the clinical efficacy of uric acid lowering agents in the treatment of acute exacerbations of gout.

A comprehensive search of six databases without language restrictions was conducted and included EMBASE, PubMed, Cochrane Library, Web of Science, CNKI, and WanFang data. The literature utilized was published before October 2019. Overall, six RCTs (randomized controlled trials) with 557 patients fulfilled the inclusion criteria.

For estimating the clinical efficacy of ULT in acute gout, SMD (standardized mean difference), WMD (weighted mean difference), RR (risk ratio), and 95% CI (confidence interval) were used. No statistical difference was witnessed in the pain VAS (visual analogue score) by day 3 (WMD, 0.06), ESR (erythrocyte sedimentation rate) and CRP (C-reactive protein) between the group using ULT agents and the group that was not using ULT agents.

Furthermore, the patients using ULT agents had lower serum uric acid levels (SMD, − 0.73) and showed better adherence to medication (RR, 1.40) in comparison with the patients not using ULT agents. No substantial difference in the recurrence rate of acute gout attacks (RR, 0.84) was witnessed. Thus, it may be advantageous to use uric-acid-lowering drugs at the initial stage of an acute gout attack.