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Fluctuation and change of serum urate levels and flares in gout: results from the NOR-Gout study.
Clin Rheumatol. 2022 Dec; 41(12):3817-3823.CR

Abstract

A gout attack may evolve after a purine-rich diet or alcohol and after starting urate-lowering therapy (ULT). The relationships between fluctuation and change in serum urate (SU) with the occurrence of flares were investigated in this study. In the prospective NOR-Gout study, gout patients with increased SU and a recent flare were treated to target with ULT over 1 year, with follow-up at year 2 with SU and flare as outcomes. SU and flares were assessed at both monthly and 3-monthly intervals until target SU was reached. Fluctuation over periods and changes in SU between two time points were assessed and compared in patients with and without flares. At year 1, 186 patients completed follow-up (88.2%) and 173 (82.0%) at year 2. Mean age (SD) at baseline was 56.4 (13.7) years, disease duration was 7.8 (7.6) years, and 95.3% were men. The first-year SU fluctuation and change were related to flare occurrence during year 1 (both p < 0.05). High fluctuation with an absolute sum of all SU changes during the first 9 months was related to flares over 3-month periods (all p < 0.05), and high fluctuation during the first 3 months was related to flares in months 3-6 (p = 0.04). Monthly and high SU changes or again reaching higher SU levels > 360 µmol/l were not related to flares. Fluctuation and change in SU were related to flare occurrence during the first year of ULT, while changes between visits and reaching SU levels > 360 µmol/L were not related to flares. Key Points • Urate-lowering therapy seeks to achieve a treatment target and prevent gout flares, and changes in serum urate are related to gout flares. • Fluctuation and changes in serum urate were associated with gout flares, suggesting that fluctuation in serum urate is unfavourable during gout treatment. • During urate-lowering therapy in gout in clinical practice, fluctuation of serum urate, for example, due to lack of adherence, should be observed and avoided.

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Authors+Show Affiliations

Uhlig T
Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Box 23, Vinderen, N-0319, Oslo, Norway. tillmann.uhlig@medisin.uio.no. Faculty of Medicine, University of Oslo, Oslo, Norway. tillmann.uhlig@medisin.uio.no.
Karoliussen LF
Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Box 23, Vinderen, N-0319, Oslo, Norway.
Sexton J
Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Box 23, Vinderen, N-0319, Oslo, Norway.
Kvien TK
Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Box 23, Vinderen, N-0319, Oslo, Norway. Faculty of Medicine, University of Oslo, Oslo, Norway.
Haavardsholm EA
Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Box 23, Vinderen, N-0319, Oslo, Norway. Faculty of Medicine, University of Oslo, Oslo, Norway.
Perez-Ruiz F
Division of Rheumatology, OSI EE-Cruces, Cruces University Hospital, Osakidetza, Barakaldo, Spain. Biocruces-Bizkaia Health Research Institute, Barakaldo, Spain. Medicine Department, Medicine School, University of the Basque Country, Leioa, Spain.
Hammer HB
Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Box 23, Vinderen, N-0319, Oslo, Norway. Faculty of Medicine, University of Oslo, Oslo, Norway.

MeSH

MaleHumansMiddle AgedFemaleGout SuppressantsUric AcidProspective StudiesGoutSurveys and Questionnaires

Pub Type(s)

Journal Article

Language

eng

PubMed ID

36316609

Citation

Uhlig, T, et al. "Fluctuation and Change of Serum Urate Levels and Flares in Gout: Results From the NOR-Gout Study." Clinical Rheumatology, vol. 41, no. 12, 2022, pp. 3817-3823.
Uhlig T, Karoliussen LF, Sexton J, et al. Fluctuation and change of serum urate levels and flares in gout: results from the NOR-Gout study. Clin Rheumatol. 2022;41(12):3817-3823.
Uhlig, T., Karoliussen, L. F., Sexton, J., Kvien, T. K., Haavardsholm, E. A., Perez-Ruiz, F., & Hammer, H. B. (2022). Fluctuation and change of serum urate levels and flares in gout: results from the NOR-Gout study. Clinical Rheumatology, 41(12), 3817-3823. https://doi.org/10.1007/s10067-022-06416-4
Uhlig T, et al. Fluctuation and Change of Serum Urate Levels and Flares in Gout: Results From the NOR-Gout Study. Clin Rheumatol. 2022;41(12):3817-3823. PubMed PMID: 36316609.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Fluctuation and change of serum urate levels and flares in gout: results from the NOR-Gout study. AU - Uhlig,T, AU - Karoliussen,L F, AU - Sexton,J, AU - Kvien,T K, AU - Haavardsholm,E A, AU - Perez-Ruiz,F, AU - Hammer,H B, Y1 - 2022/11/01/ PY - 2022/08/26/received PY - 2022/10/16/accepted PY - 2022/10/11/revised PY - 2022/11/2/pubmed PY - 2022/11/16/medline PY - 2022/11/1/entrez KW - Flare KW - Fluctuation KW - Gout KW - Serum urate KW - Treat to target KW - Urate-lowering treatment SP - 3817 EP - 3823 JF - Clinical rheumatology JO - Clin Rheumatol VL - 41 IS - 12 N2 - A gout attack may evolve after a purine-rich diet or alcohol and after starting urate-lowering therapy (ULT). The relationships between fluctuation and change in serum urate (SU) with the occurrence of flares were investigated in this study. In the prospective NOR-Gout study, gout patients with increased SU and a recent flare were treated to target with ULT over 1 year, with follow-up at year 2 with SU and flare as outcomes. SU and flares were assessed at both monthly and 3-monthly intervals until target SU was reached. Fluctuation over periods and changes in SU between two time points were assessed and compared in patients with and without flares. At year 1, 186 patients completed follow-up (88.2%) and 173 (82.0%) at year 2. Mean age (SD) at baseline was 56.4 (13.7) years, disease duration was 7.8 (7.6) years, and 95.3% were men. The first-year SU fluctuation and change were related to flare occurrence during year 1 (both p < 0.05). High fluctuation with an absolute sum of all SU changes during the first 9 months was related to flares over 3-month periods (all p < 0.05), and high fluctuation during the first 3 months was related to flares in months 3-6 (p = 0.04). Monthly and high SU changes or again reaching higher SU levels > 360 µmol/l were not related to flares. Fluctuation and change in SU were related to flare occurrence during the first year of ULT, while changes between visits and reaching SU levels > 360 µmol/L were not related to flares. Key Points • Urate-lowering therapy seeks to achieve a treatment target and prevent gout flares, and changes in serum urate are related to gout flares. • Fluctuation and changes in serum urate were associated with gout flares, suggesting that fluctuation in serum urate is unfavourable during gout treatment. • During urate-lowering therapy in gout in clinical practice, fluctuation of serum urate, for example, due to lack of adherence, should be observed and avoided. SN - 1434-9949 UR - https://www.unboundmedicine.com/medline/citation/36316609/Fluctuation_and_change_of_serum_urate_levels_and_flares_in_gout:_results_from_the_NOR_Gout_study_ DB - PRIME DP - Unbound Medicine ER -