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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Main Authors: Till Uhlig, Lars F. Karoliussen, Joe Sexton, Tore K. Kvien, Espen A. Haavardsholm, Fernando Perez-Ruiz, Hilde Berner Hammer
Format: Article
Language:English
Published: BMC 2022-04-01
Series:Arthritis Research & Therapy
Subjects:
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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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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