Background/Purpose: Urate lowering therapy (ULT) is expected to prevent new gout flares. Treat-to-target ULT is however often not performed, and more evidence on how often patient experience flares during ULT is needed.

We studied how many patients had a gout flare during months 6-12 in the first year during a treat-to-target strategy, and which factors predicted a flare during that time.

Methods: In a prospective observational study, 208 patients with crystal-proven gout with a recent gout attack and insufficiently treated serum urate (sUA) level ( >360 μmol/L/ >6 mg/dl) were included. They received ULT with drug escalation during monthly follow-up until the target sUA level was met (sUA < 360 μmol/L, or < 300 μmol/L if clinical tophi). Assessments in this ongoing data collection included demographic and clinical variables, serum urate levels, previous medication with allopurinol, colchicine and NSAIDs, co-morbidities, and health related quality of life (SF-36). Flares during the last six months in the first year of follow-up with “treat-to-target” were recorded. Bivariate analyses and logistic regression analyses examined factors associated with and prediction (odds ratio with 95% confidence interval) of a flare during months 6-12.

Results: 208 patients were included, and 164 completed a 12-month follow-up: 94.3% males, 90.5% Caucasian, mean (SD) age 56.3 (13.7) years, disease duration 7.9 (7.7) years), body mass index 28.8 (4.6), sUA level 496 (81) µmol/L, and 17.9% had tophi. Allopurinol had previously been used by 27.2% (57/186), colchicine by 50.7% (106/200), NSAIDs by 75.6 % (158/203), and prednisolone by 43.5% (91/198). 67.7% of patients had no flare between 6 and 12 months. After 12 months 87.0% (141/162) had reached the treatment target sUA < 360 µmol/l, but this was not related to whether patients had a flare between months 6-12 (p=0.83). A number of variables at baseline were bivariately related to a flare: higher BMI (p< 0.002), presence of tophi (p=0.02), co-morbidities (p=0.03), previous use of colchicine (p< 0.001) or NSAIDs (p=0.04), worse physical function summary score (SF-36) (p< 0.03), and high level joint pain during strongest attack ever (p=0.001).

In multivariate logistic regression analyses, also adjusting for age and gender in the final model, a high BMI (OR 1.11 per unit (95% CI 1.02-1.21), low baseline serum urate (OR 1.006 per unit, 95% CI 1.001-1.012) and previous use of colchicine (OR 4.8, 95% CI 2.1-11.1) predicted a flare during months 6 and 12. Also, NSAID use (OR 5.1, 95% CI 1.6-16.0), when substituting colchicine, was a predictor of a flare-free period during this period.

Conclusion: One of three patients experienced a flare during the second half of one year with treat-to-target ULT strategy. A low baseline level of sUA and high BMI increased the risk of a flare, as did previous experience with colchicine or NSAID.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/gout-flares-become-infrequent-during-a-treat-to-target-strategy-over-one-year-data-from-the-nor-gout-study/