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Abstract
Objective
To evaluate the effect of prophylactic therapy on gout flare during urate lowering treatment.
Methods
We retrospectively examined the data derived from 59 patients who had been treated with allopurinol for more than six months after stopping prophylactic medication at our rheumatology clinic. Demographic data (age, sex, disease duration, tophi and comorbidity), clinical and laboratory features, including presence of gout flare during urate lowering treatment, dose of allopurinol, serum uric acid level and creatinine clearance at initiation and six months later, were collected. For the subgroup analysis, the same data were collected in 46 patients who had been followed up at one year after stopping prophylactic medication.
Results
Twenty-eight patients among 59 (47.4%) had experienced at least 1 gouty attack during urate lowering therapy. The mean duration of prophylactic medication was not different between the flare group (3.8 months) and the non- flare group (5.9 months, p=0.617). Six months later, the mean serum uric acid level was 6.3 mg/dL (6.1 mg/dL vs. 6.5 mg/dL). According to the duration of prophylactic treatment (<6 months, ≥6 months), there were more fre-quent flares in the <6 months group than in the ≥6 months group (51.2% vs. 38.9% in the six month followup group, 70.6% vs. 50% in the one year followup group).
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Figure 1.
Cases and total frequency of gout flare according to the duration of prophylactic treatment (A, B in six months group, n=59; C, D in one year group, n=46).
Table 1.
Demographic and clinical characteristics of patients
| Total (n=59) | Flare (+), n=28 | Flare (-), n=31 | p-value∗ | |
|---|---|---|---|---|
| Age (years, mean± SD) | 54.5±12.8 | 56.4±12.3 | 52.8±13.2 | 0.221 |
| Sex (male : female) | 58 : 1 | 27 : 1 | 31 : 0 | 0.475 |
| Body mass index (kg/m2) | 25.5±2.8 | 26.3±2.8 | 24.5±2.5 | 0.032 |
| Disease duration (years) | 7.1±8.2 | 6.3±8.3 | 7.8±8.2 | 0.401 |
| Comorbidity (n, %) | ||||
| Hypertension | 26 (44.1) | 12 (42.9) | 14 (45.2) | 1.0 |
| CKD, stone | 7 (11.9) | 4 (14.3) | 3 (9.7) | 0.698 |
| Cardiovascular ds | 8 (13.6) | 3 (10.7) | 5 (16.1) | 0.709 |
| Diabetes mellitus | 8 (13.6) | 6 (21.4) | 2 (6.5) | 0.134 |
| Hyperlipidemia | 21 (35.6) | 9 (32.1) | 12 (38.7) | 0.786 |
| Arthritis pattern at onset (n, %) | 0.934 | |||
| Monoarthritis | 32 (54.2) | 16 (57.1) | 16 (51.6) | |
| Oligoarthritis | 20 (33.9) | 9 (32.1) | 11 (35.5) | |
| Polyarthritis | 7 (11.9) | 3 (10.7) | 4 (12.9) | |
| Presence of tophi (n, %) | 10 (16.9) | 4 (14.3) | 6 (19.4) | 0.734 |
| Medication pattern (n) | 0.401 | |||
| Colchicine | 38 | 20 | 18 | |
| NSAIDs | 16 | 7 | 9 | |
| Steroids | 11 | 2 | 9 | |
| Dose of allopurinol (mg) | 180.0±67.3 | 185.7±70.5 | 180.6±65.4 | 0.801 |
| Serum uric acid (mg/dL) | 9.9±1.9 | 10.2±2.2 | 9.7±1.6 | 0.522 |
| CCr (mL/min/1.73 m2) | 75.0±28.9 | 71.4±28.5 | 79.6±29.4 | 0.582 |
Table 2.
Clinical characteristics of gout flare after stopping prophylactic medication
| Six months followed up after only ULT (n=59) | Total (n=59) | Flare (+), n=28 | Flare (-), n=31 | p-value∗ |
|---|---|---|---|---|
| Duration of prophylaxis (months, mean± SD) | 4.9±6.5 | 3.8±3.5 | 5.9±8.3 | 0.617 |
| At the end of prophylaxis | ||||
| Dose of allopurinol (mg) | 261.8±97.0 | 266.0±107.1 | 258.0±88.5 | 0.657 |
| Serum uric acid (mg/dL) | 6.8±1.8 | 6.8±2.1 | 6.9±1.6 | 0.481 |
| CCr (mL/min/1.73 m2) | 73.4±26.8 | 71.0±26.1 | 76.4±28.0 | 0.653 |
| Mean frequency of flare (n) | 0.8±1.0 | 0.8±1.0 | ||
| Time interval to 1 st attack (months) | 2.4±1.6 | 2.4±1.6 | ||
| At six months after only ULT | ||||
| Dose of allopurinol (mg) | 276.7±94.2 | 294.6±97.5 | 260.0±89.4 | 0.139 |
| Serum uric acid (mg/dL) | 6.3±1.6 | 6.1±1.9 | 6.5±1.3 | 0.080 |
| CCr (mL/min/1.73 m2) | 72.1±26.5 | 69.8±28.1 | 74.8±24.8 | 0.578 |
| One year followed up after only ULT (n=46) | Total (n=46) | Flare (+), n=30 | Flare (-), n=16 | p-value∗ |
| Duration of prophylaxis (months, mean± SD) | 5.0±7.1 | 3.8±4.5 | 7.2±10.3 | 0.233 |
| Mean frequency of flare (n) | 1.3±1.3 | 1.3±1.3 | ||
| Time interval to 1 st attack (months) | 2.7±2.8 | 2.7±2.8 |
Table 3.
Clinical characteristics of patients according to the duration of prophylaxis
| Six months followed up after only ULT (n=59) | <6 months (n=41) | ≥6 months (n=18) | p-value∗ |
|---|---|---|---|
| Duration of prophylaxis (months, mean± SD) | 1.9±1.3 | 11.7±8.4 | 0.000 |
| At the end of prophylaxis | |||
| Dose of allopurinol (mg) | 242.6±78.7 | 305.5±121.1 | 0.061 |
| Serum uric acid (mg/dL) | 7.1±2.0 | 6.3±1.3 | 0.246 |
| CCr (mL/min/1.73 m2) | 71.6±28.7 | 79.1±19.3 | 0.338 |
| Gout flare (+) (n, %) | 21 (51.2) | 7 (38.9) | 0.412 |
| Mean frequency of flare (n) | 0.8±1.0 | 0.7±1.0 | 0.484 |
| Time interval to 1st attack (months) | 2.4±1.6 | 2.5±1.6 | 0.717 |
| At six months after only ULT | |||
| Dose of allopurinol (mg) | 267.0±72.9 | 300.0±132.2 | 0.384 |
| Serum uric acid (mg/dL) | 6.1±1.6 | 6.7±1.4 | 0.078 |
| CCr (mL/min/1.73 m2) | 70.3±27.6 | 77.8±22.5 | 0.391 |
Table 4.
Clinical characteristics of patients according to the duration of prophylaxis
| One year followed up after only ULT (n=46) | <6 months (n=34) | ≥6 months (n=12) | p-value∗ |
|---|---|---|---|
| Duration of prophylaxis (months, mean± SD) | 2.0±1.3 | 13.5±9.9 | 0.000 |
| At the end of prophylaxis | |||
| Dose of allopurinol (mg) | 245.5±87.3 | 291.6±124.0 | 0.302 |
| Serum uric acid (mg/dL) | 6.8±1.6 | 6.6±2.5 | 0.304 |
| CCr (mL/min/1.73 m2) | 68.5±29.6 | 72.4±8.0 | 0.766 |
| Gout flare (+) (n, %) | 24 (70.6) | 6 (50) | 0.292 |
| Mean frequency of flare (n) | 1.4±1.3 | 0.9±1.1 | 0.199 |
| Time interval to 1 st attack (months) | 2.7±3.0 | 2.5±2.2 | 0.958 |
| At one year after only ULT | |||
| Dose of allopurinol (mg) | 267.6±96.0 | 283.3±133.7 | 0.865 |
| Serum uric acid (mg/dL) | 5.8±0.8 | 6.5±1.8 | 0.244 |
| CCr (mL/min/1.73 m2) | 72.6±29.3 | 75.1±17.4 | 1.000 |
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