Dr. Dalbeth has received consulting fees, speaking fees, and/or honoraria (less than $10,000 each) from Ardea, Menarini, Metabolex, Savient, and Takeda.
Special Theme Article: Clinical Imaging and the Rheumatic Diseases
Exploratory Study of Radiographic Change in Patients With Tophaceous Gout Treated With Intensive Urate-Lowering Therapy
Article first published online: 24 DEC 2013
Copyright © 2014 by the American College of Rheumatology
Arthritis Care & Research
Volume 66, Issue 1, pages 82–85, January 2014
How to Cite
Dalbeth, N., Doyle, A. J., McQueen, F. M., Sundy, J. and Baraf, H. S. B. (2014), Exploratory Study of Radiographic Change in Patients With Tophaceous Gout Treated With Intensive Urate-Lowering Therapy. Arthritis Care Res, 66: 82–85. doi: 10.1002/acr.22059
- Issue published online: 24 DEC 2013
- Article first published online: 24 DEC 2013
- Accepted manuscript online: 8 JUL 2013 09:26AM EST
- Manuscript Accepted: 3 JUN 2013
- Manuscript Received: 29 JAN 2013
- Health Research Council of New Zealand
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.
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.
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.
This exploratory study suggests that profound urate lowering can lead to improvement in structural damage, particularly bone erosion, in patients with tophaceous gout.