One- and 2-year flare rates after treat-to-target and tight-control therapy of gout: results from the NOR-Gout study
Abstract Objectives To explore the frequency and predictors of flares over 2 years during a treat-to-target strategy with urate-lowering therapy (ULT) in patients with gout. Methods In the treat-to-target, tight control NOR-Gout study patients started ULT with escalating doses of allopurinol. Flares...
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BMC
2022-04-01
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Series: | Arthritis Research & Therapy |
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Online Access: | https://doi.org/10.1186/s13075-022-02772-3 |
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author | Till Uhlig Lars F. Karoliussen Joe Sexton Tore K. Kvien Espen A. Haavardsholm Fernando Perez-Ruiz Hilde Berner Hammer |
author_facet | Till Uhlig Lars F. Karoliussen Joe Sexton Tore K. Kvien Espen A. Haavardsholm Fernando Perez-Ruiz Hilde Berner Hammer |
author_sort | Till Uhlig |
collection | DOAJ |
description | Abstract Objectives To explore the frequency and predictors of flares over 2 years during a treat-to-target strategy with urate-lowering therapy (ULT) in patients with gout. Methods In the treat-to-target, tight control NOR-Gout study patients started ULT with escalating doses of allopurinol. Flares were recorded over 2 years. Baseline predictors of flares during months 9–12 in year 1 and during year 2 were analyzed by multivariable logistic regression. Results Of 211 patients included (mean age 56.4 years, disease duration 7.8 years, 95% males), 81% (150/186) of patients experienced at least one gout flare during the first year and 26% (45/173) during the second year. The highest frequency of flares in the first year was seen during months 3–6 (46.8% of patients). Baseline crystal depositions detected by ultrasound and by dual-energy computed tomography (DECT) were the only variables which predicted flares both during the first period of interest at months 9–12 (OR 1.033; 95% CI 1.010–1.057, and OR 1.056; 95% CI 1.007–1.108) and also in year 2. Baseline subcutaneous tophi (OR 2.42, 95% CI 1.50–5.59) and prior use of colchicine at baseline (OR 2.48, 95% CI 1.28-4.79) were independent predictors of flares during months 9–12, whereas self-efficacy for pain was a protective predictor (OR 0.98 per unit, 95% CI 0.964–0.996). Conclusions In patients with gout, flares remain frequent during the first year of a treat-to-target ULT strategy, especially during months 3–6, but are much less frequent during year 2. Baseline crystal depositions predict flares over 2 years, supporting ULT early during disease course. Trial registration ACTRN12618001372279 |
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language | English |
last_indexed | 2024-12-11T12:35:36Z |
publishDate | 2022-04-01 |
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series | Arthritis Research & Therapy |
spelling | doaj.art-1a5f87e14d14442b91f730f8873962a72022-12-22T01:07:08ZengBMCArthritis Research & Therapy1478-63622022-04-0124111110.1186/s13075-022-02772-3One- and 2-year flare rates after treat-to-target and tight-control therapy of gout: results from the NOR-Gout studyTill Uhlig0Lars F. Karoliussen1Joe Sexton2Tore K. Kvien3Espen A. Haavardsholm4Fernando Perez-Ruiz5Hilde Berner Hammer6Division of Rheumatology and Research, Diakonhjemmet HospitalDivision of Rheumatology and Research, Diakonhjemmet HospitalDivision of Rheumatology and Research, Diakonhjemmet HospitalDivision of Rheumatology and Research, Diakonhjemmet HospitalDivision of Rheumatology and Research, Diakonhjemmet HospitalOsakidetza, OSI EE-Cruces, Division of Rheumatology, Cruces University HospitalDivision of Rheumatology and Research, Diakonhjemmet HospitalAbstract Objectives To explore the frequency and predictors of flares over 2 years during a treat-to-target strategy with urate-lowering therapy (ULT) in patients with gout. Methods In the treat-to-target, tight control NOR-Gout study patients started ULT with escalating doses of allopurinol. Flares were recorded over 2 years. Baseline predictors of flares during months 9–12 in year 1 and during year 2 were analyzed by multivariable logistic regression. Results Of 211 patients included (mean age 56.4 years, disease duration 7.8 years, 95% males), 81% (150/186) of patients experienced at least one gout flare during the first year and 26% (45/173) during the second year. The highest frequency of flares in the first year was seen during months 3–6 (46.8% of patients). Baseline crystal depositions detected by ultrasound and by dual-energy computed tomography (DECT) were the only variables which predicted flares both during the first period of interest at months 9–12 (OR 1.033; 95% CI 1.010–1.057, and OR 1.056; 95% CI 1.007–1.108) and also in year 2. Baseline subcutaneous tophi (OR 2.42, 95% CI 1.50–5.59) and prior use of colchicine at baseline (OR 2.48, 95% CI 1.28-4.79) were independent predictors of flares during months 9–12, whereas self-efficacy for pain was a protective predictor (OR 0.98 per unit, 95% CI 0.964–0.996). Conclusions In patients with gout, flares remain frequent during the first year of a treat-to-target ULT strategy, especially during months 3–6, but are much less frequent during year 2. Baseline crystal depositions predict flares over 2 years, supporting ULT early during disease course. Trial registration ACTRN12618001372279https://doi.org/10.1186/s13075-022-02772-3GoutTreat to targetFlareUrate lowering treatmentPredictor |
spellingShingle | Till Uhlig Lars F. Karoliussen Joe Sexton Tore K. Kvien Espen A. Haavardsholm Fernando Perez-Ruiz Hilde Berner Hammer One- and 2-year flare rates after treat-to-target and tight-control therapy of gout: results from the NOR-Gout study Arthritis Research & Therapy Gout Treat to target Flare Urate lowering treatment Predictor |
title | One- and 2-year flare rates after treat-to-target and tight-control therapy of gout: results from the NOR-Gout study |
title_full | One- and 2-year flare rates after treat-to-target and tight-control therapy of gout: results from the NOR-Gout study |
title_fullStr | One- and 2-year flare rates after treat-to-target and tight-control therapy of gout: results from the NOR-Gout study |
title_full_unstemmed | One- and 2-year flare rates after treat-to-target and tight-control therapy of gout: results from the NOR-Gout study |
title_short | One- and 2-year flare rates after treat-to-target and tight-control therapy of gout: results from the NOR-Gout study |
title_sort | one and 2 year flare rates after treat to target and tight control therapy of gout results from the nor gout study |
topic | Gout Treat to target Flare Urate lowering treatment Predictor |
url | https://doi.org/10.1186/s13075-022-02772-3 |
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