Are Target Urate and Remission Possible in Severe Gout? A Five-year Cohort Study

Abstract

Objective.Determine the proportion of patients achieving target serum urate (SU), defined as < 6 mg/dl for patients with non-severe gout and < 5 mg/dl for patients with severe gout, as well as the proportion of patients achieving remission after 5 years of followup.Methods.Patients from the Gout Study Group (GRESGO) cohort were evaluated at 6-month intervals. Demographic and clinical data were obtained at baseline. Visits included assessments of serum urate, flares, tophus burden, health-related quality of life using the EQ-5D, activity limitations using the Health Assessment Questionnaire adapted for gout, and pain level and patient’s global assessment using visual analog scales. Treatment for gout and associated diseases was prescribed according to guidelines and available drugs.Results.Of 500 patients studied, 221 had severe gout (44%) and 279 had non-severe gout (56%) at baseline. No significant differences were observed across the study in percentages of severe gout versus non-severe gout patients achieving SU 6 mg/dl or 5 mg/dl. The highest proportion of patients achieving target SU (50–70%) and remission (39%) were found after 3–4 years of followup. In the fifth year, these proportions decreased and 28% of the patients were in remission, but only 40 patients remained in the study. None of the patients with severe gout achieved remission.Conclusion.In patients with severe gout, target SU was hard to achieve and remission was not possible. The main obstacles for target SU and gout remission include poor medication adherence, persistent tophi, and loss to followup.

12-month results from the real-life observational treat-to-target and tight-control therapy NOR-Gout study: achievements of the urate target levels and predictors of obtaining this target

“…During follow-up, an sUA value of <360µml/L was numerically more frequently reached in the more ambitious approach by 83% versus 74%, but differences were not statistically significant. 28 In a Mexican study, the target sUA was achieved in only 50%-70% after 3-4 years in spite of regular visits, 29 and response rates by 12 months among general practitioners in the UK with sUA <360 µmol/L were 45%. 30 Table 2 Serum urate levels and frequency of target achievement (sUA <360 µmol/L) in patients assessed during time points.…”

Sonographic estimation of monosodium urate burden predicts the fulfillment of the 2016 remission criteria for gout: a 12-month study

“…This observation supports the need for a longitudinal assessment of gout remission over a 12-month interval. In previous studies, a variable percentage of patients, ranging from 9.1 to 48.2% [6,44,45], reached the 2016 remission criteria [7]. This heterogeneity can be explained by several factors: first, the inclusion of patients with different clinical and laboratory characteristics (e.g., presence/absence of subcutaneous tophi and different disease duration); second, the use of different ULTs (e.g., allopurinol, febuxostat and pegloticase); third, the duration of ULT prior to the enrolment; and finally, the length of the observational period (from 12 to 60 months) [5,43,44].…”

“…This heterogeneity can be explained by several factors: first, the inclusion of patients with different clinical and laboratory characteristics (e.g., presence/absence of subcutaneous tophi and different disease duration); second, the use of different ULTs (e.g., allopurinol, febuxostat and pegloticase); third, the duration of ULT prior to the enrolment; and finally, the length of the observational period (from 12 to 60 months) [5,43,44]. Interestingly, Alvarado-de la Barrera and colleagues found that the proportion of patients achieving the remission increased with the duration of ULTs [45]. In fact, 9.1%, 30%, and 39% of patients with a non-severe tophaceous gout (less than 4 subcutaneous tophi) were in remission after 12, 24, and 48 months, respectively [45].…”

“…Interestingly, Alvarado-de la Barrera and colleagues found that the proportion of patients achieving the remission increased with the duration of ULTs [45]. In fact, 9.1%, 30%, and 39% of patients with a non-severe tophaceous gout (less than 4 subcutaneous tophi) were in remission after 12, 24, and 48 months, respectively [45]. Furthermore, none of those with a severe tophaceous gout (more than 4 subcutaneous tophi) achieved the remission even after 60 months [45].…”

Is Remission a Valid Target for Gout?

“…Remission and cure are, thus, different aims. In the report by Alvarado-de la Barrera, et al 2 , in this issue of The Journal, recently developed Preliminary Criteria for the Remission of Gout -which have not undergone further validation -have been applied to patients with gout attending a tertiary center in Mexico. The characteristics of these patients have been described previously 3 as coming from a low socioeconomic background and being particularly noncompliant, having poorly managed, very severe gout, and treating their symptoms with self-prescribed glucocorticoid monotherapy 4 , a therapy associated to the early appearance of tophi 5,6 .…”