Tuesday, 25 Feb 2020

You are here

Less Structural Damage with T2T in Gout

A two‐year randomized clinical trial has demonstrated that allopurinol dose escalation to a target serum urate (SU) results in less bone erosion, structural damage and urate crystal deposition in patients with gout.

A prospective, two‐year clinical trial randomized 87 gout patients to received either convential allopurinol dosing or treat-to-target (T2T) dose escalation to achieve a target serum urate < 6mg/dl. Subjects underwent dual energy CT (DECT) scans of the feet, and radiographs (XR, hand and foot) at yearly intervals and DECT scans were scored for bone erosion and urate volume.

After 2 years, CT erosion score was higher in the control group compared in the T2T (+7.8% change vs +1.4% in the T2T group, Prandomization =0.015).

While changes in XRay erosion or narrowing scores did not differ between groups, DECT scans showed that urate volumes in the dose escalation group had reduced DECT urate volume (‐27.6 to ‐28.3%) at year 2 (p=0.023).

These findings provide evidence that imaging evidence that long‐term urate‐lowering therapy, adjusted to achieve a target serum urate can influence structural outcomes in gout.

The author has no conflicts of interest to disclose related to this subject

Add new comment

More Like This

Hyperuricemia Predisposes to Coronary Artery Disease in Men

There are numerous associations between hyperuricemia and cardiovascular disease (CVD). An analysis of the Swedish SCAPIS Pilot study shows that higher levels of serum urate (SU) are associated with an increase in coronary artery calcification score in men but not in women. SU is not associated with common carotid intima-media thickness and carotid plaque scores in either men or women.

Hypersensitivity Reactions and Gout Tx: Watch the Dose

Both allopurinol and febuxostat (Uloric) were associated with an increased risk of hypersensitivity reactions among new users of these urate-lowering therapies, a large U.S. study found.

Diabetics using SGLT2 Inhibitors have a lower Gout Risk

Researchers from the Brigham and Women's Hospital have reported that adults with type 2 diabetes who were treated with SGLT2 inhibitors had a lower risk of gout compared to GLP1 agonist, suggesting that sodium–glucose cotransporter-2 inhibitors may reduce the risk for gout with type 2 diabetes mellitus (T2DM).

A Role for SGLT2 Inhibition in Gout?

The antidiabetic medication canagliflozin (Invokana) lowered serum urate and reduced the risk of gout flare in a post-hoc analysis of data from two large clinical trials.

Predicting Inpatient Gout Flares

Analysis of New Zealand hospitalized patients revals nine predictors of inpatient flare for people with comorbid gout.

This retrospective cohort study of hospitalised patients with comorbid gout included 625 hospitalised patients, 87 experienced inpatient gout flare.

There were 9 predictors of an inpatient gout flare: