AB0879 INTRATENDINOUS TOPHI IN PATIENTS WITH GOUT: PERSISTENCE IN SPITE OF CLINICAL CONTROL AND SCOPE OF URICEMIA THERAPEUTIC TARGET
Authors: Carlos Guillén-Astete, Patricia Morán-Alvarez
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background</h3> The tendon affectation of the gout consists of the deposit of uric acid in territories habitually perientésicos causing its accumulation in the substance of the body of the tendon or occupying part of it and protruding towards zones of extension. Their presence is usually not clinically accounted for except when they obstruct tendon displacement and therefore their role as part of the clinical picture of patients with gout is often underrepresented. <h3>Objectives</h3> The purpose of this study is to determine the ultrasound response of these tophi once the clinical activity has been controlled and the serum uricemia therapeutic target of 6.0mg/dL has been reached. <h3>Methods</h3> Quasi-experimental study type before after. We include 19 patients with tophaceous gout diagnosed between 2012 and 2014 and followed regularly in three rheumatology consultations through clinical, analytical and ultrasound controls. We compared the ultrasound records of static images of your Achilles, patellar and tricipital tendons at the time of diagnosis and in your last review. The longitudinal measurements of the tophi obtained were compared. The independent variable was the evaluation time (before and after) and the dependent variables were the quantification of tophi and their measurements in the longitudinal axis. <h3>Results</h3> All the patients were male. Mean age of 58 SD 6.8 years (Range 29-76). Mean basal uric acid 11.3mg/dL. Mean follow-up time to reach therapeutic objective 18 SD 10 months (Range 9-61). Median number of intratendinous tophi (counting one for each tendon of 6 possible tendons): 2. Fashion 2 (Range 1-4). Mean longitudinal diameters: Achilles (8 cases) 18.3 SD 4.2 mm; Rotulian (11 cases) 15.3 SD 3.1 mm; Tricipital (6 cases) 9.8 SD 5.1mm. Hypouricemiant treatment administered: Alopurinol 12; Alopurinol followed by Febuxostat 7; Febuxostat only 0. In the ultrasound study, once the therapeutic objective was reached, the accounting of the intratendinous tophi Achilles and patellar tophi remained identical. One tricipital tofo disappeared completely and the rest were maintained. The longitudinal measurements of tophi that did not disappear were as follows: Achilles 18.0 SD 3.2mm (P=0.805); Rotulian 14.9 SD 3.2 (P=0.803); Tricipital 7.9 SD 3.2 (N=5, P=0.489). No differences were detected when comparing the two hypouricemiant treatment sequences. <h3>Conclusion</h3> Although this is a small retrospective cohort, our results show a poor ultrasound response of reduction of intratendinous tophi reaching the serum uricemia target of 6.0mg/dL. This observation raises two reflections: (1) On the one hand, and as already proposed, the therapeutic target of uricemia in our patients could require an even stricter adjustment and (2) on the other hand, it would be necessary to consider whether the inclusion of regulated ultrasound scans of certain tendons would have clinical value if they were routinely incorporated into the study of our patients with gout. <h3>Disclosure of Interests</h3> None declared