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Ultrasound shows rapid reduction of crystal depositions during a treat-to-target approach in gout patients: 12-month results from the NOR-Gout study
  1. Hilde Berner Hammer1,2,
  2. Lars Karoliussen1,
  3. Lene Terslev3,
  4. Espen A Haavardsholm1,
  5. Tore K Kvien1,2,
  6. Till Uhlig1,2
  1. 1 Department of Rheumatology, Diakonhjemmet Sykehus, Oslo, Norway
  2. 2 University of Oslo, Faculty of Medicine, Oslo, Norway
  3. 3 Department of Rheumatology, Glostrup University Hospital, Copenhagen, Denmark
  1. Correspondence to Dr Hilde Berner Hammer, Rheumatology, Diakonhjemmet Sykehus, Oslo 0319, Norway; hbham{at}online.no

Abstract

Objectives As ultrasound is sensitive for detecting crystal depositions in patients with gout, our objectives were to explore the main locations for depositions and the extent of dissolution of depositions during a treat-to-target approach with urate lowering treatment (ULT) in patients with gout.

Methods Patients with a recent flare of gout were consecutively included in this single-centre study and managed by a treat-to-target approach with ULT. All patients were assessed at baseline, 3, 6 and 12 months including bilateral ultrasound examinations of joints/tendons/entheses of hands, elbows, knees, ankles and feet. A new semiquantitative scoring system of 0–3 of elementary lesions (double contour (DC), tophi and aggregates) was applied to quantify the amount of depositions during the follow-up.

Results 209 of the patients were evaluated with ultrasound at baseline (mean (SD) age 56.4 (13.8) years and disease duration 7.9 (7.7) years, 95.2% men). The serum urate levels decreased from baseline to 12 months (mean (SD) 500 (77) to 312 (49) µmol/L) (p<0.001)). The first metatarsophalangeal joint was the most frequent location for all the elementary lesions and erosions were associated with higher levels of crystal depositions. From baseline to 12 months, mean sum scores decreased for DC (4.3 to 1.3), tophi (6.5 to 3.8) and aggregates (9.3 to 6.7) (p<0.001 for all), with DC being most sensitive to change.

Conclusions The ultrasound scoring system for crystal depositions was sensitive to change and showed that a treat-to-target approach with ULT resulted in significant reductions of all the depositions, most extensively for DC.

  • gout
  • ultrasonography
  • arthritis
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Footnotes

  • Handling editor Josef S Smolen

  • Presented at Some of the results from this study have been presented in a poster at EULAR 2019, and in oral presentations both at EULAR 2018 and at ACR 2019 [EULAR 2018 OP 0211, 2019 ACR/ARP Annual Meeting 898, EULAR 2019 SAT0423].

  • Contributors HBH has made a substantial contributions to the conception and design of the work; the acquisition of data, some of the analysis, interpretation of data for the work; and drafted the manuscript as well as revising it critically for important intellectual content; and given a final approval of the version to be published; and agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. LK, EAH, TKK and TU has given substantial contributions to the design of the manuscript as well as the interpretation of data for the work; and revised the manuscript critically for important intellectual content; and given a final approval of the version to be published; and agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. LT has given substantial contributions to the design of the manuscript as well as the analysis and interpretation of data for the manuscript; and revising the manuscript critically for important intellectual content; and given final approval of the version to be published; and agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

  • Funding There was no external funding, and the study was performed as employees at National Advisory Unit on Rehabilitation in Rheumatology (NKRR) and Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway.

  • Competing interests HBH reports personal fees from AbbVie, Lilly and Novartis, outside the submitted work. LT reports personal fees from Novartis, Roche, BMS and Pfizer outside the submitted work. EAH reports personal fees from Pfizer, UCB, Eli Lilly, Celgene, Janssen-Cilag, AbbVie and Gilead outside the submitted work. TKK reports grants and personal fees from AbbVie, MSD, UCB, Hospira/Pfizer, Eli-Lilly, grants from BMS, personal fees from Roche, Hikma, Orion, Sanofi, Celltrion, Sandoz, Biogen, Amgen, Egis, Ewopharma and Mylan, outside the submitted work. TU reports personal fees from Grünenthal and Novartis, outside the submitted work.

  • Patient and public involvement Patients and/or the public were involved in the design, or conduct, or reporting, or dissemination plans of this research. Refer to the Methods section for further details.

  • Patient consent for publication Not required.

  • Ethics approval The study was approved by the Norwegian Regional Committee for Medical and Health Research Ethics South East (reference number 2015/990).

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

  • Data availability statement Data are available on reasonable request. Deidentified participant data are available on reasonable request.

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