OP0209 SONOGRAPHIC ESTIMATION OF MONOSODIUM URATE BURDEN PREDICTS THE FULFILMENT OF THE 2016 REMISSION CRITERIA FOR GOUT: A 12-MONTH STUDY
Authors: E. Cipolletta, A. DI Matteo, W. Grassi, E. Filippucci
Journal: Annals of the Rheumatic Diseases (2021)

Background: Preliminary remission criteria for gout include the following five domains: serum uric acid (SUA) levels &lt;360 µmol/l, absence of subcutaneous tophi, absence of gouty flares, pain (due to gout) &lt;2/10 and patient global assessment of disease activity &lt;2/10 [1]. To achieve remission, all criteria must be fulfilled at least twice in a 12-month period [1]. Although imaging techniques allow to visualise monosodium urate (MSU) deposits and to estimate their burden, an imaging domain was not included. Objectives: To investigate whether baseline MSU burden estimated by ultrasonography (US) predicts the achievement of remission according to these criteria [1] over 12 months. Methods: In this 12-month prospective, observational and monocentric study, patients with gout according to the 2015 ACR/EULAR criteria and on urate-lowering therapy for at least the preceding 6 months were consecutively recruited. After the baseline clinical assessment, only patients fulfilling all domains of the remission criteria [1] (and therefore amenable to achieve the remission at 12 months) were followed up at 6-month intervals for one year. The US findings indicative of MSU deposits were identified according to the OMERACT definitions. The following joints were included in the US scanning protocol: elbows, wrists, 2 nd metacarpophalangeal joints, knees, ankles and 1 st metatarsophalangeal joints. Sum scores of aggregates, double contour (DC) signs, and tophi were calculated separately, and a total score resulting from the sum of all elementary US findings was recorded. Results: Seventy patients with gout were recruited; of these, 20 (28.6%) were excluded at baseline because 13 (18.6%) did not satisfy the SUA domain, 11 (15.7%) tophus domain, 7 (10.0%) pain domain and 5 (7.1%) disease activity domain. In the enrolled patients (Age: 59.9±14.8 years, female/male ratio: 1/49, disease duration: 6.5±6.6 years), remission criteria were fulfilled in 21 (42.0%) of 50 patients over 12 months. No significant difference was found between patients fulfilling and not fulfilling the remission criteria at 12 months in all clinical and laboratory data except for the gout flare prophylaxis (7, 33.3% vs 20, 69.0%; p=0.02). The baseline US MSU burden was significantly lower (total score 1.9±1.8) in patients in remission than in those not in remission at 12 months (total score 5.1±3.1) (p&lt;0.01). The fulfilment of the remission criteria at 12 months was recorded in 87.5% of the patients without baseline US evidence of MSU deposits and in only 33.0% of those with at least one US finding indicating MSU deposits (p&lt;0.01). US scores and gout flare prophylaxis were the only significant predictors of remission in the univariate analyses (Table 1). Table 1. Predictive values of baseline data for the remission at 12 months. OR (95%CI ) P value Ongoing flare prophylaxis 0.23 (0.07-0.75) 0.02 Total score=0 10.83 (1.14-102.59) 0.04 Aggregate score=0 5.53 (1.34-22.76) &lt;0.01 DC sign score=0 7.33 (1.71-31.44) &lt;0.01 Tophus score=0 3.88 (1.08-13.92) 0.02 95%CI: 95% confidence interval; OR: odds ratio. The risk of not fulfilling the remission criteria increased with the US burden of MSU deposits. For each 1-point increase in total score, aggregate score, DC sign score and tophus score, the risk increased by 1.81- (95%CI: 1.27-2.60), 1.73- (95%CI: 1.14-2.64), 4.16- (95%CI: 1.55-11.3) and 1.95-fold (95%CI: 1.07-3.56), respectively (Figure 1). Conclusion: Baseline US estimation of MSU burden is an independent predictor of gout clinical remission at 12 months. The absence of US MSU deposits was the most significant predictor of remission, whereas the US detection of DC sign in at least one joint of not achieving remission. Thus, performing an US examination in patients amenable to fulfil the remission criteria after 12 months may improve risk-stratification and inform management of these patients. References: [1]de Lautour H, et al. Development of Preliminary Remission Criteria for Gout Using Delphi and 1000Minds Consensus Excersices. Arthritis Care Res 2016; 68 :667–72 Disclosure of Interests: Edoardo Cipolletta: None declared, Andrea Di Matteo: None declared, Walter Grassi Speakers bureau: Walter Grassi has received speaking fees from AbbVie, Celgene, Grünenthal, Pfizer and Union Chimique Belge Pharma., Emilio Filippucci Speakers bureau: Emilio Filippucci. has received speaking fees from AbbVie, Bristol-Myers Squibb, Janssen-Cilag, Novartis, Pfizer, Roche and Union Chimique Belge Pharma