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.
Aged
Allopurinol
/ administration & dosage
Bone Resorption
/ diagnostic imaging
Dose-Response Relationship, Drug
Female
Foot Bones
/ diagnostic imaging
Foot Joints
/ diagnostic imaging
Gout
/ diagnostic imaging
Gout Suppressants
/ administration & dosage
Hand Bones
/ diagnostic imaging
Hand Joints
/ diagnostic imaging
Humans
Male
Middle Aged
Tomography, X-Ray Computed
Treatment Outcome
Uric Acid
/ metabolism
Journal
Arthritis & rheumatology (Hoboken, N.J.)
ISSN: 2326-5205
Titre abrégé: Arthritis Rheumatol
Pays: United States
ID NLM: 101623795
Informations de publication
Date de publication:
10 2019
10 2019
Historique:
received:
18
10
2018
accepted:
09
05
2019
pubmed:
14
5
2019
medline:
25
2
2020
entrez:
14
5
2019
Statut:
ppublish
Résumé
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. 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. 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). 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.
Substances chimiques
Gout Suppressants
0
Uric Acid
268B43MJ25
Allopurinol
63CZ7GJN5I
Banques de données
ANZCTR
['ACTRN12611000845932']
Types de publication
Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
1739-1746Subventions
Organisme : Health Research Council of New Zealand
ID : 09-111D
Pays : International
Organisme : Health Research Council of New Zealand
ID : 11-203
Pays : International
Organisme : Health Research Council of New Zealand
ID : 15-576
Pays : International
Informations de copyright
© 2019, American College of Rheumatology.
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