Gout Remission Less Likely With Higher DECT Monosodium Urate

Adwoa Dansoa Tabi-Amponsah, BBiomedSc

Credit: Linkedin

Higher dual energy CT (DECT) monosodium urate crystal volume is associated with lower odds of gout remission after 2 years of urate-lowering therapy in people with erosive gout.¹

Lead investigator Adwoa Dansoa Tabi-Amponsah, BBiomedSc, doctoral candidate, University of Auckland, Auckland, New Zealand, and colleagues analyzed 2 years of follow-up data from 97 participants in a double-blind, randomized-controlled trial. Participants were randomized to receive oral urate-lowering therapies to a serum urate target of less than 0.20mmol/l or less than 0.30mmol/l. DECT scans of the feet and ankles were performed for all participants at baseline.

The investigators found that 11 out of 97 participants (11%) at year 1 and 21 out of 92 participants (23%) achieved gout remission according to the 2016 preliminary gout remission criteria. Twenty-six (27%) out of 97 participants at year 1 and 40 out of 92 participants (44%) at year 2 met simplified gout remission criteria without the patient reported outcomes.

Using logistic multivariable regression models, Tabi-Amponsah and colleagues found that baseline DECT monosodium urate crystal volume was the only significant independent predictor of gout remission at Year 2 on both the 2016 preliminary gout remission criteria and simplified remission criteria. Each one cm3 increase in the baseline DECT monosodium urate crystal volume decreased the odds of fulfilling the 2016 preliminary gout remission criteria (0.65 [95% CI 0.46-0.93], P =.02), and the simplified gout remission criteria (0.57 [95% CI 0.41-0.78], P <.001).

Other recent research into urate-lowering therapy our of Sint Maartenskliniek and Radboud University in the Netherlands examined perspectives on 2 approaches to urate-lowering therapy: treat-to-target and treat-to-avoid-symptoms.

“Gout is the most prevalent inflammatory rheumatic disease worldwide. Long-term pharmacologic treatment is focused on reducing serum urate below its saturation point by using urate-lowering therapy. The treatment goals are the prevention of recurrent flares and the development of irreversible joint damage and the dissolution of tophi,” lead investigator Iris Rose Peeters, MD, Sint Maartenskliniek and Radboud University, and colleagues wrote.²

Peeters and colleagues conducted a qualitative study, a semistructured interview study, followed by a quantitative study, a maximum difference scaling survey. The qualitative study provided insight into barriers and facilitators when considering a continued treat-to-target and treat-to-avoid-symptoms discontinuation approach. These qualitative data were summarized into neutral items that were then presented to a larger group of patients to determine which factors play a role when considering the 2 different treatment approaches.²

The investigators found that the perceived risk of joint damage and gout flares were the most important concerns to be addressed with treatment. Another important consideration was that urate-lowering therapy use gives some assurance. On the other hand, costs, ease of receiving therapy, and its practical use were the least important items.²

“These results can aid shared decision-making and provide input for what is important to discuss with patients with gout in remission when they consider urate-loweirng discontinuation. The emphasis should be on the risk of having gout flares and joint damage, not so much on facilitating how easily medication is received,” Peeters and colleagues wrote.²

REFERENCES
1. Tabi-Amponsah, AD, Stewart, S, Gamble, G, et al. Baseline dual energy computed tomography urate volume predicts fulfillment of gout remission after two years of urate-lowering therapy. Arthritis Care Res. Published online August 12, 2024.doi: 10.1002/acr.25414
2. Peeters IR, Veenstra F, Wanten SAC,et al. Perspective of Dutch Patients with Gout on Continuation or Discontinuation of Urate-Lowering Therapy During Remission: A Mixed-Methods Study. Arthritis Care Res. Published online June 24, 2024. doi.org/10.1002/acr.25392