Background/Purpose:

Little is known regarding the differences in characteristics between patients with tophaceous gout compared to those without tophi.  We examined these differences in a national cohort of gout patients. 

Methods:

Patients enrolled by their rheumatologist within the Consortium of Rheumatology Researchers of North America (CORRONA) gout registry between 11/1/12 and 5/12/13 were included. All gout patients were eligible for enrollment regardless of disease severity, disease activity or medication use. Data was gathered at the time of routine clinical visits from patients and their treating rheumatologists including demographics, gout characteristics, comorbid conditions, current treatments, laboratory results and physical exam findings, including presence of tophi. Specifically we examined medication use and successful compliance with respect to target treatment goals (e.g., gouty flares and serum urate levels).

Results:

There were 54 rheumatologists across the US who enrolled 524 gout patients who were predominately men (79%), with a mean age of 64 years (±13.6), disease duration of 10 years (± 9.6), and maximum uric acid level of 9 (±2.1) at the time of diagnosis. Associated cardiovascular disease was common in both those with tophi (n=116) and those without (n=407) (73% vs. 65%, p=0.12).  Patients with tophi were more likely to have chronic kidney disease (29% vs. 14%, p=0.001).  There was a trend towards a greater prevalence of diabetes mellitus in patients with tophi (25% vs. 19%, p=0.192) In addition, those with tophi, more often had to avoid the use of nonsteroidal anti-inflammatory drugs for acute gouty flares (33% vs. 20%, p<0.01).  While use of urate-lowering therapy was common in those with tophi (60% allopurinol, 28% febuxostat, 5% pegloticase and 3% probenecid), only 58% of patients had achieved a SUA ≤6mg/dl (39% <5mg/dl).  Both those with and without tophi had active disease with a mean of 4 and 3 gout flares respectively in the prior 12 months.

Conclusion:

Most of the gout patients had active disease and not reached target SUA levels. Those with tophi are more likely to have chronic kidney disease and were less likely to be able to tolerate commonly prescribed medications to treat gouty flares.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/assessing-treat-to-target-in-gout-patients-with-and-without-tophi/