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Effects of Allopurinol Dose Escalation on Bone Erosion and Urate Volume in Gout: A Dual-Energy Computed Tomography Imaging Study Within a Randomized, Controlled Trial.
Dalbeth, Nicola; Billington, Karen; Doyle, Anthony; Frampton, Christopher; Tan, Paul; Aati, Opetaia; Allan, Jordyn; Drake, Jill; Horne, Anne; Stamp, Lisa K.
Afiliación
  • Dalbeth N; University of Auckland, Auckland, New Zealand.
  • Billington K; Auckland District Health Board, Auckland, New Zealand.
  • Doyle A; Auckland District Health Board and University of Auckland, Auckland, New Zealand.
  • Frampton C; University of Otago Christchurch, Christchurch, New Zealand.
  • Tan P; University of Auckland, Auckland, New Zealand.
  • Aati O; University of Auckland, Auckland, New Zealand.
  • Allan J; University of Auckland, Auckland, New Zealand.
  • Drake J; University of Otago Christchurch, Christchurch, New Zealand.
  • Horne A; University of Auckland, Auckland, New Zealand.
  • Stamp LK; University of Otago Christchurch, Christchurch, New Zealand.
Arthritis Rheumatol ; 71(10): 1739-1746, 2019 10.
Article en En | MEDLINE | ID: mdl-31081595
ABSTRACT

OBJECTIVE:

To examine whether allopurinol dose escalation to achieve serum urate (SU) target can influence bone erosion or monosodium urate (MSU) crystal deposition, as measured by dual-energy computed tomography (DECT) in patients with gout.

METHODS:

We conducted an imaging study of a 2-year randomized clinical trial that compared immediate allopurinol dose escalation to SU target with conventional dosing for 1 year followed by dose escalation to target, in gout patients who were receiving allopurinol and who had an SU level of ≥0.36 mmoles/liter. DECT scans of feet and radiographs of hands and feet were obtained at baseline, year 1, and year 2 visits. DECT scans were scored for bone erosion and urate volume.

RESULTS:

Paired imaging data were available for 87 patients (42 in the dose-escalation group and 45 in the control group). At year 2, the progression in the CT erosion score was higher in the control group than in the dose-escalation group (+7.8% versus +1.4%; P = 0.015). Changes in plain radiography erosion or narrowing scores did not differ between groups. Reductions in DECT urate volume were observed in both groups. At year 2, patients in the control group who had an SU level of <0.36 mmoles/liter and patients in the dose-escalation group had reduced DECT urate volume (-27.6 to -28.3%), whereas reduction in DECT urate volume was not observed in control group patients with an SU level of ≥0.36 mmoles/liter (+1.5%) (P = 0.023).

CONCLUSION:

These findings provide evidence that long-term urate-lowering therapy using a treat-to-SU-target strategy can influence structural damage and reduce urate crystal deposition in gout.
Asunto(s)

Texto completo: 1 Base de datos: MEDLINE Asunto principal: Ácido Úrico / Resorción Ósea / Alopurinol / Supresores de la Gota / Articulaciones del Pie / Articulaciones de la Mano / Gota Tipo de estudio: Clinical_trials Idioma: En Revista: Arthritis Rheumatol Año: 2019 Tipo del documento: Article

Texto completo: 1 Base de datos: MEDLINE Asunto principal: Ácido Úrico / Resorción Ósea / Alopurinol / Supresores de la Gota / Articulaciones del Pie / Articulaciones de la Mano / Gota Tipo de estudio: Clinical_trials Idioma: En Revista: Arthritis Rheumatol Año: 2019 Tipo del documento: Article