Prognostic factors associated with early gout flare recurrence in patients initiating urate-lowering therapy during an acute gout flare

C A Janssen,H E Vonkeman,M A H Oude Voshaar,P M Ten Klooster,M A F J Van De Laar

doi:10.1007/s10067-019-04566-6

Abstract

Lowering serum urate levels below the threshold for crystal formation with urate-lowering therapy (ULT) has been associated with a lower risk for gout flare reoccurrences. However, gout patients on ULT still commonly suffer from recurring gout flares. The purpose of this study was to explore prognostic factors associated with gout flare recurrence within the first 3 months, in gout patients starting ULT during an acute gout flare. Post-hoc analysis of trial data on acute gout patients randomized to either gout flare standard of care or anakinra treatment were used, including baseline demographic, laboratory, clinical, and patient-reported variables, as well as 3-month follow-up data on gout flare recurrences. Only patients starting ULT at baseline were included. Using variable selection based on clinical relevance, univariate, and multivariate binary logistic regression analyses were done to examine predictors of gout flare reoccurrence. A total of 75 patients were included in this study, of which 36 (48%) experienced a gout flare ≤ 3 months post baseline. The multivariate regression analysis revealed that CRP levels > 30 mg/L (OR 9.47) and lack of prophylaxis when starting ULT (OR 11.56) were independently associated with gout flare recurrence. Similar results were found for the univariate regression analyses. Our results show that CRP levels > 30 mg/L and lack of prophylaxis when starting ULT were prognostic factors for early gout flare reoccurrence in patients starting ULT during an acute gout flare.Key Points• Gout flare recurrences were common within the first 3 months after starting urate-lowering therapy in gout patients.• Intake of prophylaxis when starting ULT had a strong protective effect on gout flare recurrences.• C-reactive protein level > 30 mg/L was an additional prognostic factor for early (≤ 3 months) gout flare reoccurrence in patients starting ULT during an acute gout flare.

Highlights

Introductionserum urate (SUA) target of < 0.36 mmol/L with urate-lowering therapy (ULT) has been associated with reduced risk of gout flare recurrences and other adverse outcomes [1, 2]
Lowering serum urate (SUA) levels below the threshold for monosodium urate crystal formation to the recommendedSUA target of < 0.36 mmol/L with urate-lowering therapy (ULT) has been associated with reduced risk of gout flare recurrences and other adverse outcomes [1, 2]
Of the original 88 included patients, two patients never initiated ULT during the study, eight patients failed to initiate ULT at baseline, and three patients were lost to follow-up, leaving a total of 75 eligible patients who were included in the present analysis

Summary

Introduction

SUA target of < 0.36 mmol/L with urate-lowering therapy (ULT) has been associated with reduced risk of gout flare recurrences and other adverse outcomes [1, 2]. Most current gout management guidelines recommend to consider and discuss ULT with every patient, and to initiate ULT for patients with frequent flares, arthropathy, renal impairment, or tophi [2, 3]. Previous studies have shown that frequently recurrent gout (i.e., having ≥ 3 flares per year) is associated with. While preventing recurrent gout flares is considered a priority for improving gout outcomes, not much is currently known about prognostic factors that place patients at increased risk for recurrent gout flares, especially in the period shortly after initiating ULT [6, 9, 10]. No previous studies have been performed in patients who initiate ULT during an acute gout flare [11–13]

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