Influence of antihyperuricemic therapy on the clinical and radiographic progression of gout

Abstract

Ten years ago, we studied the clinical and radiographic manifestations of gout in 60 patients and described 3 patterns of disease. To determine the consequences of management over a 10-year period, we recently reassessed the 39 available patients of this population. We found that although reduced tophaceous deposition on physical examination correlated with normalization of the serum urate concentration, no correlation existed between radiographic changes and mean serum urate concentrations. Progression of gouty changes on radiography reflected progressive deformity on physical examination, We have described the radiographic changes that occurred in a well-characterized Population of subjects with gout over 10 years and determined that serum urate concentrations alone may not provide an effective means of monitoring the progression of tophaceous disease in bone. Gouty arthritis remains a management problem in some populations, despite the availability of a precise diagnostic test and effective serum u r a t e lowering medications. Ten years ago, we reported a clinical, biochemical, and radiographic evaluation of a population in which tophaceous gout was frequent (1).We concluded 1) that tophi develop in bone before becoming apparent on physical examination; 2) that bony changes can occur in joints that were never the site of acute gout; and 3) that the development of tophi is a direct consequence of the seventy and duration of the disease. A reassessment of these patients was undertaken to determine the consequences of medical management over the intervening decade, and those findings form the basis of this report.

Multinational evidence-based recommendations for the diagnosis and management of gout: integrating systematic literature review and expert opinion of a broad panel of rheumatologists in the 3e initiative

“…The association of SUA with other potential outcomes22 was systematically reviewed. Six studies linked the reduction of SUA levels with a decreased rate of acute attacks,94–99 two studies with tophus regression,100 101 and three studies with crystal disappearance—either through US102 or synovial fluid microscopy 103 104. The quality of these studies was low to moderate.…”

Dual Energy CT: added value in gouty arthritis

“…Untreated patients with nonproven phi still can contribute to chrondolysis (15). Monitoring of therapy effect on tophi number and volume would be worthwhile and different methods of tophus assessment have been reviewed (16).…”

Management of gout

“…Indeed, several longterm outcomes are related to the long-term sustained control of SU level beyond 6 mg/dL, such as reduction of gout flares (70) and tophi (70). By contrast, poor control of SU has been shown to be associated with no change or even worsening of tophaceous deposition (71). Efficacious SU control has also been associated with the disappearance of MSU crystals from synovial fluid samples (72)(73)(74).…”