Diet choice matters less than sticking to it in hyperuricaemia, and gout flares cluster in the first week of weight loss

The edition in brief

In a 12-week open-label trial, 102 men with overweight or obesity and hyperuricaemia were randomised to calorie-restricted carbohydrate-restricted, DASH or low-purine diets. Weight fell by about 8.5 kg (9.3%) and serum urate by 0.5 to 0.9 mg/dL, with no significant difference between diets; DASH had the best adherence and preserved more lean mass than carbohydrate restriction. Capillary urate rose transiently in the first week, when gout flares peaked, so flare risk deserves attention when structured weight loss begins. A model built from 649 PEXIVAS participants estimates the two-year risk of first relapse in ANCA-associated vasculitis from sex, induction agent, ANCA type, presentation features and eGFR, with moderate discrimination (AUC 0.71) and no external validation yet. A seven-variable clinical model identified proliferative lupus nephritis with an AUC of 0.90 in external validation but does not replace biopsy. The FDA recorded a supplement to the etanercept licence, an administrative action. The pearl covers continuing urate-lowering therapy through a flare.