Background/Purpose: OMERACT has proposed domains to evaluate the effect of treatment in patients with acute and chronic gout. Their frequency, time to improve and percentage of change have not been evaluated in chronic gout patients under conventional treatment.

Methods: This is a prospective, longitudinal and observational cohort study. Since July 2010, we included all patients with Gout diagnosis (ACR criteria), attending for the 1st time to 2 Rheumatology departments. All signed informed consent and were evaluated by a rheumatologist in each visit. Variables: Demographic, clinical/biochemical related to gout and associated diseases, previous treatments. Individualized, regular treatment was prescribed in 1st visit as recommended (Life style modifications, NSAID, ULT, prophylaxis and treatment for associated diseases). Response to treatment evaluations: Number of: painful, swollen, limited to motion joints, tophi and flares/6mo. Main tophi size, VAS pain, general health (patient and physician), HAQ and uricemia. Statistical analysis. Chi square and paired t test.

Results: 178 Gout patients had been included in this prospective study. This report includes 93 patients with baseline and 6 mo evaluations. Males 97%, mean ± SD age, age at onset and duration of the disease: 49.7 ± 11.68; 35.82 ± 12.84 and 13.7 ± 10.46 years respectively; in 40%, disease duration was <3 ys. Tophaceous gout: 61% (29%, ≥ 5 tophi). Most had been irregularly treated, 58% previous auto-prescribed glucocorticoids. More frequent associated diseases: Hypertrygliceridemia 53%, hypertension 52% and obesity 30%. Allopurinol prescribed doses were: 341.9 ± 280.7 and 382.4 ± 215.9 mg/day (baseline and 6mo respectively); although, at 6 mo 69% had uric acid >6 mg/dL, the group improved significantly in 7/11 outcome domains (see table). 

Response to treatment. Variables according to OMERACT domains.

Variable, mean ± SD	Baseline	6mo	P	>25% improvement (%)
Flares/6mo	2.6 ±3.6	0.6± 1.2	0.000	72
Painful joints	2.4±4.5	2.2 ± 4.7	NS	29
Swollen joints	0.53 ±1.2	0.25 ± 0.8	0.025	21
Limited joints	4.2 ± 7.9	3.5 ± 7.01	0.000	23
Tophi	5.8 ± 8.75	5.8 ±8.5	NS	10
Main tophi size, cm	3.6 ± 4.06	3.0 ±3.7	0.004	22
HAQ	0.45 ± 0.6	0.29 ± 0.5	0.012	39
Serum uric acid, mg/dL	7.9 ± 2.2	7.1 ± 1.9	0.001	34
VAS pain	4.6 ±3.2	3.7 ±3.2	0.024	36
VAS health, patient	3.8± 2.9	3.3 ± 2.9	NS	39
VAS health, physician	3.7 ± 2.6	3.6 ± 2.3	NS	47

Conclusion:  Before uricemia is controlled and as soon as the first 6 months, patients with longstanding and severe disease under regular treatment, improve significantly in 7/11 OMERACT domains, particularly acute flares and HAQ score.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/chronic-gout-improvement-according-to-outcome-meaures-in-rheumatology-domains-in-daily-clinical-practice/