Abstract
BackgroundAlthough typically a late feature of gout, tophi may present early in the course of disease. The aim of this study was to identify factors associated with the presence of early tophaceous disease.MethodsPeople with gout for <10 years were prospectively recruited, and had a comprehensive clinical assessment including examination for subcutaneous tophi. The clinical factors independently associated with the presence and number of tophi were analyzed using regression models.ResultsOf the 290 participants, there were 47 (16.2%) with clinically apparent tophi. In univariate analysis, those with tophi were older, were more frequently taking diuretics and colchicine prophylaxis, and had lower creatinine clearance. The association between the presence of tophi and creatinine clearance was strongest in those with creatinine clearance ≤30 ml/min. In logistic regression analysis, creatinine clearance ≤30 ml/min was associated with the presence of tophi, even after adjusting for ethnicity, corticosteroid use, colchicine use and diuretic use (multivariate adjusted odds ratio 7.0, p = 0.005). Participants with tophi reported higher frequency of gout flares, pain scores, patient global assessment scores, and HAQ scores.ConclusionsThe presence of tophi is associated with more symptomatic disease in people with gout for <10 years. Creatinine clearance is independently associated with early presentation of subcutaneous tophi.
Highlights
Typically a late feature of gout, tophi may present early in the course of disease
Creatinine clearance ≤30 ml/min was associated with the presence of tophi, even after adjusting for ethnicity, corticosteroid use, colchicine use and diuretic use
Other factors such as diuretic use and older age were associated with presence of tophi in univariate analysis, these factors were not independently associated with early tophaceous disease when creatinine clearance was included in the regression models
Summary
Typically a late feature of gout, tophi may present early in the course of disease. Gouty tophi have major clinical relevance, as they contribute to musculoskeletal disability and reduced health-related quality of life [7,8]. These lesions are typically a late feature of gout, gouty tophi occasionally present early in the course of disease, either as the initial manifestation of gout or within a few years of first gout flare. The factors associated with early presentation of subcutaneous tophi in people with gout have not been reported The aim of this analysis was to identify factors associated with the presence of early tophaceous disease
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