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Prognostic factors associated with early gout flare recurrence in patients initiating urate-lowering therapy during an acute gout flare.
Clin Rheumatol. 2019 Aug; 38(8):2233-2239.CR

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.

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Publisher Full Text (DOI)

Authors+Show Affiliations

Janssen CA
Department of Psychology, Health and Technology, Arthritis Center Twente, University of Twente, PO BOX 217, 7500 AE, Enschede, The Netherlands. C.A.Janssen@utwente.nl.
Oude Voshaar MAH
Department of Psychology, Health and Technology, Arthritis Center Twente, University of Twente, PO BOX 217, 7500 AE, Enschede, The Netherlands.
Ten Klooster PM
Department of Psychology, Health and Technology, Arthritis Center Twente, University of Twente, PO BOX 217, 7500 AE, Enschede, The Netherlands.
Vonkeman HE
Department of Psychology, Health and Technology, Arthritis Center Twente, University of Twente, PO BOX 217, 7500 AE, Enschede, The Netherlands. Department of Rheumatology and Clinical Immunology, Medisch Spectrum Twente, Enschede, The Netherlands.
van de Laar MAFJ
Department of Psychology, Health and Technology, Arthritis Center Twente, University of Twente, PO BOX 217, 7500 AE, Enschede, The Netherlands. Department of Rheumatology and Clinical Immunology, Medisch Spectrum Twente, Enschede, The Netherlands.

MeSH

AdultAgedC-Reactive ProteinDouble-Blind MethodFemaleFollow-Up StudiesGoutGout SuppressantsHumansMaleMiddle AgedMultivariate AnalysisPrognosisRecurrenceRegression AnalysisRheumatologyUric Acid

Pub Type(s)

Journal Article
Multicenter Study
Randomized Controlled Trial

Language

eng

PubMed ID

31030363

Citation

Janssen, C A., et al. "Prognostic Factors Associated With Early Gout Flare Recurrence in Patients Initiating Urate-lowering Therapy During an Acute Gout Flare." Clinical Rheumatology, vol. 38, no. 8, 2019, pp. 2233-2239.
Janssen CA, Oude Voshaar MAH, Ten Klooster PM, et al. Prognostic factors associated with early gout flare recurrence in patients initiating urate-lowering therapy during an acute gout flare. Clin Rheumatol. 2019;38(8):2233-2239.
Janssen, C. A., Oude Voshaar, M. A. H., Ten Klooster, P. M., Vonkeman, H. E., & van de Laar, M. A. F. J. (2019). Prognostic factors associated with early gout flare recurrence in patients initiating urate-lowering therapy during an acute gout flare. Clinical Rheumatology, 38(8), 2233-2239. https://doi.org/10.1007/s10067-019-04566-6
Janssen CA, et al. Prognostic Factors Associated With Early Gout Flare Recurrence in Patients Initiating Urate-lowering Therapy During an Acute Gout Flare. Clin Rheumatol. 2019;38(8):2233-2239. PubMed PMID: 31030363.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Prognostic factors associated with early gout flare recurrence in patients initiating urate-lowering therapy during an acute gout flare. AU - Janssen,C A, AU - Oude Voshaar,M A H, AU - Ten Klooster,P M, AU - Vonkeman,H E, AU - van de Laar,M A F J, Y1 - 2019/04/27/ PY - 2019/02/06/received PY - 2019/04/15/accepted PY - 2019/04/09/revised PY - 2019/4/29/pubmed PY - 2020/2/18/medline PY - 2019/4/29/entrez KW - Flares KW - Gout KW - Prognostic factors KW - Urate-lowering therapy SP - 2233 EP - 2239 JF - Clinical rheumatology JO - Clin Rheumatol VL - 38 IS - 8 N2 - 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. SN - 1434-9949 UR - https://www.unboundmedicine.com/medline/citation/31030363/Prognostic_factors_associated_with_early_gout_flare_recurrence_in_patients_initiating_urate_lowering_therapy_during_an_acute_gout_flare_ DB - PRIME DP - Unbound Medicine ER -