SAT0363 Are “target-urate” and remission criteria possible in severe gout? a real life experience in a cohort
Authors: J. Vazquez-Mellado, C. O. Lopez-Lopez, E. Alvarez-Hernandez, I. Pelaez-Ballestas, C. Gomez-Ruiz, A. Vazquez-Mellado, R. Burgos-Vargas
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Background</h3> Gout remission, quality of life and disability improvement are the main objectives of chronic treatment. Gout T2T goal is to achieve and maintain target urate &lt;6 mg/dL and &lt;5 mg/dL (TU) in severe gout (SG). <h3>Objectives</h3> To determine in a cohort of gout patients, SG frequency, associated factors, percentage of patients achieving TU and remission criteria. <h3>Methods</h3> Patients with gout (ACR-EULAR) from GRESGO cohort were included and evaluated at baseline and bi-annually. At baseline visit, information about gout, life style changes and treatment were discussed with the patients and relatives. Prescription for gout and associated diseases was according to published guides and available drugs. Measures: demographic, clinical and biochemical. HAQ, EUROQoL, VAS-pain and global health. SG:≥5 tophi and/or intradermal tophi. TU:sUA &lt;6 mg/dL and &lt;5 mg/dL; remission according to published proposal (de Lautour H/2016). This protocol was approved by the local IRB, all patients signed informed consent. Statistical analysis: t test, X2, Friedman, multiple-correlation and multivariable analysis. <h3>Results</h3> At baseline visit 500 gout patients were included, (221/44% with SG and 279/56% non-SG). Males 97%, all received individualised ULT treatment (allopurinol and/or probenecid). The whole group, improved significantly during follow-up in urate, flares, tophus burden, HAQ, pain, EUROQoL and renal function. SG patients were significantly: younger at onset, with lower educational level, socioeconomic status, more laboral absenteeism. Also, had longer disease duration and significant differences in all clinical variables related to severity:&gt;joint count,&gt;index tophi size, &gt;% lithiasis,&gt;HAQ score,&gt;EUROQoL and&lt;MDRD, all these outcomes improved significantly during follow-up. In multivariate analysis, disease duration (p0.008) and flares/years (p0.055) persist significantly associated to SG at baseline. SG patients received significantly higher allopurionol doses (&gt;600 mg/day) and required more frequently glucocorticoids. Eleven patients died, 1 year after baseline ~50% patients were lost. Among those that continued, target urate &lt;6 mg/dL was possible in only 50%–70% of the patients followed for 3–5 years. Less than 50% of patients achieved TU&lt;5 mg/dL during long follow-up. There were no significant differences in most percentages of TU 6 or 5 mg/dL between SG VS non-SG patients (see table 1). Although, both groups improved significantly in all clinical outcomes. Remission definition require none tophi and at least 12 months follow-up, it was observed in 9.4% of non-SG patients. <h3>Percentage of patients achieved TU</h3> (*significant differences) TU&lt;6 mg/dL&lt;5 mg/dL <h3>Conclusions</h3> In our population, SG is very frequent and associated with younger age at onset, low socioeconomic and educational level, longer duration and severe disease. Although they receive more intense treatment according to availability, TU and remission criteria are seldom observed and very difficult to achieve. Earlier diagnosis, intensive and adequate treatment should change these results. <h3>Disclosure of Interest</h3> None declared