AB0894 CHANGE OF ULTRASONOGRAPHIC SIGNS DURING URATE LOWERING THERAPY IN PATIENTS WITH GOUT
Authors: Yu Wang, Zhuoli Zhang
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background</h3> US is widely used in clinical practise in gout diagnosis and follow up. However, the crystal resolution time is not widely studied in gout patients by ultrasonography. <h3>Objectives</h3> To explore related factors of changes in gouty patients by ultrasonography after initiation of uric acid lowering therapy. <h3>Methods</h3> There were 72 gout patients enrolled who admitted to First hospital of Peking University from December 2012 to June 2017. All the patients had clinical and ultrasound examination at both knees, ankles and feet joints at the baseline. Regular uric acid lowering therapy started for one year. The endpoint was the last time who repeat the ultrasound examination during the follow up. According with uric acid level and its measuring time, the area under the curve was calculated to reflect the uric acid burden. <h3>Results</h3> In the 216 joint regions of 72 patients, double contour sign were detectable in 112/216(;51.85%), tophi were detectable in 71/216(;32.87%). Among MTP Joints, DCS was detected in 32/144 (22.22%), and tophi in 47/144 (32.64%). Among Knee joints, DCS was detected in 33/144 (22.92%), tophi in 4/144 (2.78%). Among ankle joints, DCS was detected in 47/144(;32.64%), tophi in 20/144(;13.89%). DCS disappearance occurred in 38/55 (69.09%) joints positive for DCS at baseline.Time-to-disappearance was 148 days (63-985 days). Tophi disappeared completely in 18/45 joints (40%). Time-to-disappearance was 382.5 days(;397.25–686 days). There was no significant difference in age, BMI, duration of disease and complications between DCS persisted group and DCS disappearance group. SUA in the DCS disappeared group at baseline, second, third, fourth and ninth months of follow-up was significantly lower than that of the non-disappeared group. SUA load in the DCS group was significantly lower than the non-disappeared group. Post hoc tests showed that SUA levels fell significantly from baseline through fourth month of follow-up in DCS disappeared group, and SUA of the sixth months was the lowest. <h3>Conclusion</h3> To screen for specific features of gout such as DCS or tophi by US at initiation of ULT and during follow-up is a useful, and effective modality to detect the lowering and often disappearance of burden of urate load in gouty joints. <h3>References</h3> [1] Kiltz U, Smolen J, Bardin T, et al. Treat-to-target (T2T) recommendations for gout[J]. Annals of the Rheumatic Diseases,2017,76(4):632-638. [2] Pascual E, Sivera F. Time required for disappearance of urate crystals from synovial fluid after successful hypouricaemic treatment relates to the duration of gout[J]. Ann Rheum Dis,2007,66(8):1056-1058. [3] Neogi T, Jansen T L T A, Dalbeth N, et al. 2015Gout classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative[J]. Annals of the Rheumatic Diseases,2015,74(10):1789-1798. [4] Gutierrez M, Schmidt WA, Thiele RG, et al. OMERACT Ultrasound Gout Task Force group. International Consensus for ultrasound lesions in gout: results of Delphi process and web-reliability exercise[J]. Rheumatology(Oxford), 2015, 54(10): 1797–1805. [5] Peiteado D, Villalba A, Martín-Mola E, et al. Ultrasound sensitivity to changes in gout: a longitudinal study after two years of treatment. Clin Exp Rheumatol. 2017 Sep-Oct;35(5):746-751. [6] Ebstein E, Forien M, Norkuviene E, et al. Ultrasound evaluation in follow-up of urate-lowering therapy in gout: the USEFUL study. Rheumatology (Oxford). 2018Oct4. doi: 10.1093/rheumatology/key303. [Epub ahead of print] <h3>Disclosure of Interests</h3> None declared