Esther Ebstein1, Marine Forien1, Eleonora Norkuviene2, Pascal Richette3, Gaël Mouterde4, Claire Daien4, Hang-Korng Ea3, Claire Brière3, Frédéric Lioté3, Mykolas Petraitis2, Thomas Bardin3, Jérémy Ora3, Philippe Dieudé1, Sébastien Ottaviani5. 1. Rheumatology Department, DHU FIRE, Pôle infection immunité, Bichat Hospital (AP-HP), 75018 Paris, France. 2. Rheumatology Department, Lithuanian University of Health Sciences, Kaunas, Lithuania. 3. Rheumatology Department, centre Viggo Petersen, pole appareil locomoteur, Lariboisière Hospital (AP-HP); Inserm UMR 1132, USPC, 75010 Paris, France. 4. Rheumatology Department, Lapeyronie hospital, EA 2415, Montpellier University, 34090 Montpellier, France. 5. Rheumatology Department, DHU FIRE, Pôle infection immunité, Bichat Hospital (AP-HP), 75018 Paris, France. Electronic address: sebastien.ottaviani@aphp.fr.
Abstract
OBJECTIVES: To determine whether changes in ultrasonography (US) features of monosodium urate crystal deposition is associated with the number of gouty flares after stopping gout flare prophylaxis. METHODS: We performed a 1-year multicentre prospective study including patients with proven gout and US features of gout. The first phase of the study was a 6-month US follow-up after starting urate-lowering therapy (ULT) with gout flare prophylaxis. After 6 months of ULT, gout flare prophylaxis was stopped, followed by a clinical follow-up (M6 to 12) and ULT was maintained. Outcomes were the proportion of relapsing patients between M6 and M12 according to changes of US features of gout and determining a threshold decrease in tophus size according to the probability of relapse. RESULTS: We included 79 gouty patients [mean (±SD) age 61.8±14 years, 91% males, median disease duration 4 (IQR 1.5;10) years]. Among the 49 completers at M12, 23 (47%) experienced relapse. Decrease in tophus size ≥50% at M6 was more frequent without than with relapse (54% vs. 26%, P=0.049). On ROC curve analysis, a threshold decrease of 50.8% in tophus size had the best sensitivity/specificity ratio to predict relapse [AUC 0.649 (95% confidence interval 0.488; 0.809)]. Probability of relapse was increased for patients with a decrease in tophus size <50% between M0 and M6 [OR 3.35 (95% confidence interval 0.98; 11.44)]. CONCLUSION: A high reduction in US tophus size is associated with lower probability of relapse after stopping gout prophylaxis. US follow-up may be useful for managing ULT and gout flare prophylaxis.
OBJECTIVES: To determine whether changes in ultrasonography (US) features of monosodium urate crystal deposition is associated with the number of gouty flares after stopping gout flare prophylaxis. METHODS: We performed a 1-year multicentre prospective study including patients with proven gout and US features of gout. The first phase of the study was a 6-month US follow-up after starting urate-lowering therapy (ULT) with gout flare prophylaxis. After 6 months of ULT, gout flare prophylaxis was stopped, followed by a clinical follow-up (M6 to 12) and ULT was maintained. Outcomes were the proportion of relapsing patients between M6 and M12 according to changes of US features of gout and determining a threshold decrease in tophus size according to the probability of relapse. RESULTS: We included 79 gouty patients [mean (±SD) age 61.8±14 years, 91% males, median disease duration 4 (IQR 1.5;10) years]. Among the 49 completers at M12, 23 (47%) experienced relapse. Decrease in tophus size ≥50% at M6 was more frequent without than with relapse (54% vs. 26%, P=0.049). On ROC curve analysis, a threshold decrease of 50.8% in tophus size had the best sensitivity/specificity ratio to predict relapse [AUC 0.649 (95% confidence interval 0.488; 0.809)]. Probability of relapse was increased for patients with a decrease in tophus size <50% between M0 and M6 [OR 3.35 (95% confidence interval 0.98; 11.44)]. CONCLUSION: A high reduction in US tophus size is associated with lower probability of relapse after stopping gout prophylaxis. US follow-up may be useful for managing ULT and gout flare prophylaxis.
Authors: Jennifer S Weaver; Ernest R Vina; Peter L Munk; Andrea S Klauser; Jamie M Elifritz; Mihra S Taljanovic Journal: J Clin Med Date: 2021-12-29 Impact factor: 4.241
Authors: Edoardo Cipolletta; Jacopo Di Battista; Marco Di Carlo; Andrea Di Matteo; Fausto Salaffi; Walter Grassi; Emilio Filippucci Journal: Arthritis Res Ther Date: 2021-07-09 Impact factor: 5.156