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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.