Norway: Gout Study Findings

A treat-to-target approach with urate lowering therapy caused a significant reduction of ultrasound-detected crystal depositions after 12 months in gout patients, according to a recent study in the Annals of the Rheumatic Diseases. Further, an ultrasound scoring system for crystal depositions was found to be sensitive to change.

Ultrasound is sensitive to changes for the detection of crystal deposition in gout patients. Hilde Berner Hammer, Department of Rheumatology, Diakonhjemmet Sykehus, Oslo, Norway, and colleagues explored the main locations for depositions and the extent of dissolution of depositions during a treat-to-target approach with urate-lowering treatment (ULT) in gout patients.

This single-center study consecutively included patients with a recent flare of gout. They were managed by a treat-to-target approach with ULT. The patients were assessed at baseline, 3, 6, and 12 months including bilateral ultrasound examinations of joints/tendons/entheses of hands, elbows, knees, ankles, and feet. During follow-up, the number of depositions were quantified by applying a new semiquantitative scoring system of 0–3 of elementary lesions (double contour (DC), tophi, and aggregates).

209 of the patients were evaluated with ultrasound at baseline (mean (SD) age 56.4 (13.8) years and disease duration 7.9 (7.7) years, 95.2% were men).

Key findings of the study include:

• The serum urate levels decreased from baseline to 12 months (mean (SD) 500 (77) to 312 (49) µmol/L).
• The first metatarsophalangeal joint was the most frequent location for all the elementary lesions and erosions were associated with higher levels of crystal depositions.
• From baseline to 12 months, mean sum scores decreased for DC (4.3 to 1.3), tophi (6.5 to 3.8) and aggregates (9.3 to 6.7), with DC being most sensitive to change.

"The ultrasound scoring system for crystal depositions was sensitive to change and showed that a treat-to-target approach with ULT resulted in significant reductions of all the depositions, most extensively for DC," concluded the authors.

For further reference log on to:
Hammer HB, Karoliussen L, Terslev L, Haavardsholm EA, Kvien TK, Uhlig T. Ultrasound shows rapid reduction of crystal depositions during a treat-to-target approach in gout patients: 12-month results from the NOR-Gout study. Ann Rheum Dis. Published online July 15, 2020. doi:10.1136/annrheumdis-2020-217392