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From the Journals

Gout Remission Linked to Lower Urate, Fewer Flares

Remission in gout after urate-lowering therapy was seldom after 1 but high after 5 years, finds a five-year NOR-Gout study tracking 211 patients.

Conexiant

A 5-year observational study found that sustained urate-lowering therapy may help achieve long-term remission in gout.

In the NOR-Gout study, published in Seminars in Arthritis and Rheumatism, researchers followed 211 patients with crystal-proven gout and elevated serum urate (sUA) levels. Remission rates increased over time, with the highest rates observed using a simplified remission definition.

At year 1, remission was achieved among 4.6% of patients under the preliminary criteria, rising to 38.5% by year 5. A modified preliminary definition yielded remission rates of 5.1% at year 1 and 44.1% at year 5. The simplified definition—excluding patient-reported outcomes—identified the most patients in remission: 7.7% at year 1 and 58.6% at year 5. Remission correlated with reduced structural damage and improved quality of life.

Conducted at a hospital-based rheumatology clinic, the study required participants to have recent gout flares and baseline sUA levels above 360 µmol/L. Patients followed a treat-to-target ULT regimen, primarily with allopurinol (mean dose = 262 mg/day) or febuxostat (57 mg/day among those intolerant to allopurinol). Follow-ups at years 1, 2, and 5 assessed remission using three definitions:

  • Preliminary (2016): No flares, sUA < 360 µmol/L, no tophi, pain < 2/10, global assessment < 2/10
  • Modified Preliminary: No flares, sUA < 360 µmol/L, no tophi, pain and global assessment < 3/10
  • Simplified: No flares, no tophi, sUA < 360 µmol/L (excluding patient-reported outcomes).

By year 5, 71.0% of patients maintained sUA below 360 µmol/L, 84.0% reported no flares in the prior year, and 95.1% had no detectable tophi. Patients in remission reported improved quality of life, with better SF-36 mental (MCS) and physical (PCS) component scores. DECT scans at years 1 and 2 showed reduced urate deposition in those achieving remission.

"The simplified definition identified more patients in remission than the preliminary and the modified preliminary definition at years 2 and 5. All three definitions discriminated for SF-36 MCS, PCS or DECT," said lead study author Till Uhlig, of the Center for Treatment of Rheumatic and Musculoskeletal Diseases at the Diakonhjemmet Hospital in Oslo, and colleagues.

The study supported a treat-to-target approach in gout management and suggested that a simplified remission definition may be a practical tool for clinicians.

Full disclosures are available in the study.