Uhlig Till, Karoliussen Lars F, Sexton Joe, Kvien Tore K, Haavardsholm Espen A, Perez-Ruiz Fernando, Hammer Hilde Berner
Division of Rheumatology and Research, Diakonhjemmet Hospital, Box 23, Vinderen, N-0319, Oslo, Norway.
Faculty of Medicine, University of Oslo, Oslo, Norway.
Arthritis Res Ther. 2022 Apr 20;24(1):88. doi: 10.1186/s13075-022-02772-3.
To explore the frequency and predictors of flares over 2 years during a treat-to-target strategy with urate-lowering therapy (ULT) in patients with gout.
In the treat-to-target, tight control NOR-Gout study patients started ULT with escalating doses of allopurinol. Flares were recorded over 2 years. Baseline predictors of flares during months 9-12 in year 1 and during year 2 were analyzed by multivariable logistic regression.
Of 211 patients included (mean age 56.4 years, disease duration 7.8 years, 95% males), 81% (150/186) of patients experienced at least one gout flare during the first year and 26% (45/173) during the second year. The highest frequency of flares in the first year was seen during months 3-6 (46.8% of patients). Baseline crystal depositions detected by ultrasound and by dual-energy computed tomography (DECT) were the only variables which predicted flares both during the first period of interest at months 9-12 (OR 1.033; 95% CI 1.010-1.057, and OR 1.056; 95% CI 1.007-1.108) and also in year 2. Baseline subcutaneous tophi (OR 2.42, 95% CI 1.50-5.59) and prior use of colchicine at baseline (OR 2.48, 95% CI 1.28-4.79) were independent predictors of flares during months 9-12, whereas self-efficacy for pain was a protective predictor (OR 0.98 per unit, 95% CI 0.964-0.996).
In patients with gout, flares remain frequent during the first year of a treat-to-target ULT strategy, especially during months 3-6, but are much less frequent during year 2. Baseline crystal depositions predict flares over 2 years, supporting ULT early during disease course.
ACTRN12618001372279.
探讨痛风患者在采用降尿酸治疗（ULT）的达标治疗策略期间2年内痛风发作的频率及预测因素。
在达标、严格控制的NOR - Gout研究中，患者开始使用逐渐递增剂量的别嘌醇进行ULT治疗。记录2年内的痛风发作情况。通过多变量逻辑回归分析第1年9 - 12个月及第2年痛风发作的基线预测因素。
纳入的211例患者（平均年龄56.4岁，病程7.8年，95%为男性）中，81%（150/186）的患者在第1年至少经历1次痛风发作，第2年为26%（45/173）。第1年痛风发作频率最高出现在3 - 6个月（46.8%的患者）。通过超声和双能计算机断层扫描（DECT）检测到的基线晶体沉积是在第1年9 - 12个月的首个观察期以及第2年期间均能预测痛风发作的唯一变量（比值比1.033；95%置信区间1.010 - 1.057，以及比值比1.056；95%置信区间为1.007 - 1.108）。基线皮下痛风石（比值比2.42，95%置信区间1.50 - 5.59）和基线时曾使用秋水仙碱（比值比2.48，95%置信区间1.28 - 4.79）是9 - 12个月期间痛风发作的独立预测因素，而疼痛自我效能是一个保护性预测因素（每单位比值比0.98，95%置信区间0.964 - 0.996）。
痛风患者在达标ULT治疗策略的第1年，痛风发作仍然频繁，尤其是在3 - 6个月，但在第2年发作频率明显降低。基线晶体沉积可预测2年内的痛风发作，支持在疾病病程早期进行ULT治疗。
ACTRN12618001372279。
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