Premium
Exploratory Study of Radiographic Change in Patients With Tophaceous Gout Treated With Intensive Urate‐Lowering Therapy
Author(s) -
Dalbeth Nicola,
Doyle Anthony J.,
McQueen Fiona M.,
Sundy John,
Baraf Herbert S. B.
Publication year - 2014
Publication title -
arthritis care and research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.032
H-Index - 163
eISSN - 2151-4658
pISSN - 2151-464X
DOI - 10.1002/acr.22059
Subject(s) - medicine , gout , radiography , tophus , uric acid , surgery , hyperuricemia
Objective Tophi are strongly associated with structural damage in gout, and urate‐lowering therapy reduces tophus size. Pegloticase leads to dramatic reductions in serum urate and subcutaneous tophi in treatment responders. The aim of this analysis was to examine whether profound urate lowering can alter radiographic findings in gout. Methods Serial plain radiographs of the hands and feet were obtained from 8 patients with tophaceous gout treated with pegloticase. Radiographs were scored for erosion and joint space narrowing (JSN) according to the gout‐modified Sharp/van der Heijde method. Scorers were blinded to each other's scores and to the clinical characteristics of the patients (including the clinical response to pegloticase). A detailed qualitative site‐by‐site analysis was undertaken to define additional changes observed from baseline. Results All patients experienced a profound urate‐lowering response (serum urate level <1 mg/dl) during pegloticase treatment. For the entire group, the median total radiographic scores reduced from 69.25 (range 1.5–138) at baseline to 57.25 (range 1.5–110) at 12 months ( P = 0.02). Median erosion scores reduced over 1 year ( P = 0.008), but JSN scores did not change ( P = 0.50). Further reductions were observed in total scores and erosion scores in 5 patients with 24‐month followup films (one‐way analysis of variance P = 0.009 for total score, 0.02 for erosion, and 0.95 for JSN). Qualitative site‐by‐site analysis identified regression of soft tissue masses, increased sclerosis, and filling in of erosions in the followup films. Conclusion This exploratory study suggests that profound urate lowering can lead to improvement in structural damage, particularly bone erosion, in patients with tophaceous gout.