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Urate-lowering therapy (ULT) reduces non-episodic foot pain in patients who fail to meet ACR/EULAR 2015 gout classification criteria: an effect predicted by ultrasound and potential rationale for reclassification
  1. Yousef Mohammed Alammari1,
  2. Diana Gheta1,
  3. Rachael Mary Flood1,
  4. Gerard Boran2,
  5. David J Kane1,
  6. Ronan Hugh Mullan1
  1. 1 Department of Rheumatology, Tallaght University Hospital, Dublin, Ireland
  2. 2 Department of Clinical Chemistry, Tallaght University Hospital, Dublin, Ireland
  1. Correspondence to Professor Ronan Hugh Mullan, Department of Rheumatology, Tallaght University Hospital, Dublin D24 NR0A, Ireland; mullanrh{at}

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Gout, which is caused by monosodium urate (MSU) deposition within joints in the presence of hyperuricaemia, is now the leading cause of inflammatory arthritis within developed countries.1 2 Despite recent observations that urate-lowering therapy (ULT) should be considered early to reduce disease chronicity, diagnosis is frequently delayed, leading to suboptimal clinical outcomes.2 3

The current American College of Rheumatology (ACR)/European League Against Rheumatism (EULAR) 2015 gout classification entry criterion requires the history of a prior episode of swelling, pain or tenderness of a peripheral joint/bursa before confirmation either through MSU crystal identification in synovial fluid or through achieving a score of >8 using a predefined scoring system of radiological, laboratory and clinical features. One such feature, a gout ‘episode’, is clearly defined both in terms of its intensity (joint erythema, tenderness, reduced/inhibited walking ability) and duration (time to maximal pain from onset <24 hour; resolution to baseline <14 days).4

Emerging evidence that the joints of asymptomatic hyperuricaemic individuals contain MSU deposits and that alternative presentations of foot pain occur in hyperuricaemia suggests that preclinical and clinical phases may occur prior to a first episodic gout attack.5 6 This case–control study evaluated urate deposition …

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  • Handling editor Josef S Smolen

  • Correction notice This article has been corrected since it published Online First. The P value in the fourth paragraph has been corrected.

  • Contributors YA obtained informed consent from research participants, participated in follow-up visits and co-wrote this article. RM designed the study, performed the statistical analysis and wrote the article. YA and RM both performed baseline ultrasounds on all cases to reach consensus on the findings. DG assisted with patient recruitment. RF obtained baseline patient data. GB provided access to and performed serum urate analysis. DK provided mentorship on the acquisition of ultrasound images for this study. RM is responsible for the overall content as guarantor.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval Ethical approval was obtained from the Tallaght University and St James’s Hospitals Ethics Review Board.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional unpublished data is available from this study to anyone.