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Treatment of chronic gout. Can we determine when urate stores are depleted enough to prevent attacks of gout?
J Rheumatol 2001; 28(3):577-80JR

Abstract

OBJECTIVE

To determine if lowering of serum uric acid (SUA) concentrations below 6 mg/dl or longer duration of lowered SUA will result in depletion of urate crystals from the knee joints and prevent further attacks of gout.

METHODS

A prospective study was initiated 10 years ago at Philadelphia VA Medical Center to attempt to maintain SUA levels of patients with crystal proven gout at < 6.0 mg/dl. We recalled all 57 patients who were available during 1999. Patients were divided into 2 groups: Group A, with SUA still > 6 mg/dl, and Group B, with SUA < or = 6 mg/dl. A knee joint aspirate was requested from all asymptomatic Group B patients and many in Group A. Aspirates were examined by polarized light microscopy for identification of crystals.

RESULTS

There were no differences between the groups in age, sex, duration of gout, or serum creatinine. Group A (n = 38) had a mean of 6 attacks of gout for the recent year, those with tophi having the most frequent attacks. Among the 16 patients in this group who agreed to knee aspiration, monosodium urate (MSU) crystals were found in 14, although they were asymptomatic at the time. Nineteen patients (Group B) were able to maintain serum urate levels < or = 6 mg/dl for > 12 months. Nearly half of them had no attack of gout for 2 or more years, with a mean of 1 attack in the last year for the whole group. Three patients in whom tophi were found did not have major flares of gout within the past year. Knee joint aspiration was done on 16 asymptomatic patients. Seven (44%) still had MSU crystals present in their knees. Patients in this group who were taking prophylactic colchicine did not differ with respect to the character of synovial fluid from those who had discontinued it for up to several years, although the frequency of attacks was less in those who continued colchicine.

CONCLUSION

A majority of patients were able to deplete urate crystal stores in their knee joint fluids when their SUA levels were kept to < or = 6 mg/dl for several years. The mechanisms for persistence in some patients, and whether such crystals have clinical implications, are not known. Patients with chronic gout need serum urate concentrations to be kept low to prevent further attacks.

Authors+Show Affiliations

Department of Medicine, Hospital of the University of Pennsylvania, USA. julielyu@mozcom.comNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

11296962

Citation

Li-Yu, J, et al. "Treatment of Chronic Gout. Can We Determine when Urate Stores Are Depleted Enough to Prevent Attacks of Gout?" The Journal of Rheumatology, vol. 28, no. 3, 2001, pp. 577-80.
Li-Yu J, Clayburne G, Sieck M, et al. Treatment of chronic gout. Can we determine when urate stores are depleted enough to prevent attacks of gout? J Rheumatol. 2001;28(3):577-80.
Li-Yu, J., Clayburne, G., Sieck, M., Beutler, A., Rull, M., Eisner, E., & Schumacher, H. R. (2001). Treatment of chronic gout. Can we determine when urate stores are depleted enough to prevent attacks of gout? The Journal of Rheumatology, 28(3), pp. 577-80.
Li-Yu J, et al. Treatment of Chronic Gout. Can We Determine when Urate Stores Are Depleted Enough to Prevent Attacks of Gout. J Rheumatol. 2001;28(3):577-80. PubMed PMID: 11296962.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Treatment of chronic gout. Can we determine when urate stores are depleted enough to prevent attacks of gout? AU - Li-Yu,J, AU - Clayburne,G, AU - Sieck,M, AU - Beutler,A, AU - Rull,M, AU - Eisner,E, AU - Schumacher,H R,Jr PY - 2001/4/12/pubmed PY - 2001/7/6/medline PY - 2001/4/12/entrez SP - 577 EP - 80 JF - The Journal of rheumatology JO - J. Rheumatol. VL - 28 IS - 3 N2 - OBJECTIVE: To determine if lowering of serum uric acid (SUA) concentrations below 6 mg/dl or longer duration of lowered SUA will result in depletion of urate crystals from the knee joints and prevent further attacks of gout. METHODS: A prospective study was initiated 10 years ago at Philadelphia VA Medical Center to attempt to maintain SUA levels of patients with crystal proven gout at < 6.0 mg/dl. We recalled all 57 patients who were available during 1999. Patients were divided into 2 groups: Group A, with SUA still > 6 mg/dl, and Group B, with SUA < or = 6 mg/dl. A knee joint aspirate was requested from all asymptomatic Group B patients and many in Group A. Aspirates were examined by polarized light microscopy for identification of crystals. RESULTS: There were no differences between the groups in age, sex, duration of gout, or serum creatinine. Group A (n = 38) had a mean of 6 attacks of gout for the recent year, those with tophi having the most frequent attacks. Among the 16 patients in this group who agreed to knee aspiration, monosodium urate (MSU) crystals were found in 14, although they were asymptomatic at the time. Nineteen patients (Group B) were able to maintain serum urate levels < or = 6 mg/dl for > 12 months. Nearly half of them had no attack of gout for 2 or more years, with a mean of 1 attack in the last year for the whole group. Three patients in whom tophi were found did not have major flares of gout within the past year. Knee joint aspiration was done on 16 asymptomatic patients. Seven (44%) still had MSU crystals present in their knees. Patients in this group who were taking prophylactic colchicine did not differ with respect to the character of synovial fluid from those who had discontinued it for up to several years, although the frequency of attacks was less in those who continued colchicine. CONCLUSION: A majority of patients were able to deplete urate crystal stores in their knee joint fluids when their SUA levels were kept to < or = 6 mg/dl for several years. The mechanisms for persistence in some patients, and whether such crystals have clinical implications, are not known. Patients with chronic gout need serum urate concentrations to be kept low to prevent further attacks. SN - 0315-162X UR - https://www.unboundmedicine.com/medline/citation/11296962/Treatment_of_chronic_gout__Can_we_determine_when_urate_stores_are_depleted_enough_to_prevent_attacks_of_gout L2 - http://www.jrheum.org/cgi/pmidlookup?view=long&amp;pmid=11296962 DB - PRIME DP - Unbound Medicine ER -