Session Information
Session Type: Abstract Submissions (ACR)
Background/Purpose
Gout is a recurrent inflammatory arthritis caused by crystal deposition of monosodium urate, which can be prevented urate-lowering agents such as allopurinol. However, gout attack can still recur during urate-lowering therapy. In this study we investigated the risk factors associated with recurrence of gout attacks during allopurinol treatment.
Methods
A total of 527 gout patients were enrolled, who took allopurinol at least for 6 months at Rheumatology Clinic of Seoul National University Hospital between March 2001 and March 2013. The patients were divided into those who have ever experienced recurrence of gout attack (recurrence group) and those who haven’t (non-recurrence group) during allopurinol treatment. To reveal the risk factors for gout recurrence, we compared baseline deomographic characteristics, concomitant diseases, uric acid level, creatinine level, presence of tophi, type of prophylactic treatment (non-steroidal anti-inflammatory drugs, colchcine, glucocorticoids) and concomitant treatment. Multiple logistic regression analysis was applied to find the best model to explain the recurrence.
Results
The mean (SD) age of the enrolled patients was 58.7 (14.9) years and 96.2% were male. The patients were followed-up for mean (SD) duration of 3.17 (2.64) years. During urate-lowering therapy, 323 patients (61.3%) experienced recurrence of gout attack. In recurrence group, baseline uric acid level was significantly higher than non-recurrence group (8.6 ± 2.0 vs 8.1 ± 1.9 mg/dL, p=0.0043 by Student t-test). The presence of tophi was more commonly observed in recurrence group (29.4% vs 18.6%, p=0.006 by chisquare test). The other variables showed no difference between recurrence and non-recurrence groups, which include age, sex, concomitant diseases, the presence of urinary stone, the type of prophylaxis treatment and initial creatinine level. In multivariate logistic regression analysis, high uric acid level (Uric acid > 8.5 mg/dl) and the presence of tophi were found to be risk factors for gout attack during allopurinol treatment (Table 1).
Conclusion
Our study revealed that patients who show uric acid level > 8.5 mg/dL and/or tophi at baseline have higher risk for recurrence of gout attack during allopurinol treatment. Adequate education and closer follow-up will be required for those risky patients when allopurinol is started.
Table 1. Risk factors for recurrence of gout attack during allopurinol treatment, multivariate logistic regression analysis
|
Clinical variables |
Odds ratio |
95% confidence interval |
P-value |
|
Tophi |
1.78 |
1.16-2.74 |
0.009 |
|
Serum uric acid ³8.5 mg/dL |
1.54 |
1.07-2.21 |
0.019 |
|
Prophylaxis |
|||
|
NSAID |
0.72 |
0.36-1.44 |
0.3555 |
|
Colchicine |
1.03 |
0.648-1.628 |
0.911 |
|
NSAID+colchicine |
2.57 |
0.897-7.381 |
0.079 |
|
Glucocorticoid |
0.82 |
0.45-1.50 |
0.522 |
Disclosure:
M. J. Yoon,
None;
J. A. Yang,
None;
S. H. Joo,
None;
S. J. Lee,
None;
J. Y. Moon,
None;
H. M. Kwon,
None;
D. J. Ko,
None;
Y. W. Song,
None;
E. B. Lee,
None.
« Back to 2014 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/risk-factors-for-gout-attack-recurrence-during-urate-lowering-allopurinol-treatment/