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Medientyp:
E-Artikel
Titel:
Effects of Conventional Uric Acid–Lowering Therapy on Monosodium Urate Crystal Deposits
Beteiligte:
Ellmann, Hanna;
Bayat, Sara;
Araujo, Elizabeth;
Manger, Bernhard;
Kleyer, Arnd;
Cavallaro, Alexander;
Lell, Michael;
Schenker, Hannah;
Simon, David;
Tascilar, Koray;
Baraf, Herbert S. B.;
Schett, Georg;
Rech, Jürgen
Erschienen:
Wiley, 2020
Erschienen in:
Arthritis & Rheumatology, 72 (2020) 1, Seite 150-156
Sprache:
Englisch
DOI:
10.1002/art.41063
ISSN:
2326-5191;
2326-5205
Entstehung:
Anmerkungen:
Beschreibung:
<jats:sec><jats:title>Objective</jats:title><jats:p>Few studies have systematically and quantitatively addressed the impact of urate‐lowering therapy on monosodium urate (<jats:styled-content style="fixed-case">MSU</jats:styled-content>) deposits. This study was undertaken to analyze the effect of lifestyle measures and conventional urate‐lowering therapy on <jats:styled-content style="fixed-case">MSU</jats:styled-content> deposits in patients with gout.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>In this prospective study, subjects with gout according to the American College of Rheumatology/European League Against Rheumatism classification criteria and presence of <jats:styled-content style="fixed-case">MSU</jats:styled-content> deposits seen on dual‐energy computed tomography (<jats:styled-content style="fixed-case">DECT</jats:styled-content>) scans received either lifestyle intervention or conventional urate‐lowering therapy for a mean period of 18 months before a follow‐up <jats:styled-content style="fixed-case">DECT</jats:styled-content> scan. Detected <jats:styled-content style="fixed-case">MSU</jats:styled-content> deposits were quantified by volumetric measurement and validated by semiquantitative scoring, and baseline and follow‐up measurements were compared.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Baseline and follow‐up <jats:styled-content style="fixed-case">DECT</jats:styled-content> scans were available for all 83 subjects. Six subjects discontinued treatment, and 77 subjects underwent a lifestyle intervention (n = 24) or were treated with allopurinol (n = 29), febuxostat (n = 22), or benzbromarone (n = 2) over the entire observation period. The mean serum uric acid (<jats:styled-content style="fixed-case">UA</jats:styled-content>) level decreased from 7.2 to 5.8 mg/dl in the overall population. In patients who discontinued treatment, no change in <jats:styled-content style="fixed-case">MSU</jats:styled-content> deposits or serum <jats:styled-content style="fixed-case">UA</jats:styled-content> levels was observed. The burden of <jats:styled-content style="fixed-case">MSU</jats:styled-content> deposits significantly decreased in patients undergoing lifestyle intervention (<jats:styled-content style="fixed-case">MSU</jats:styled-content> volume <jats:italic>P</jats:italic> = 0.007; <jats:styled-content style="fixed-case">MSU</jats:styled-content> score <jats:italic>P</jats:italic> = 0.001), and in patients treated with allopurinol (<jats:styled-content style="fixed-case">MSU</jats:styled-content> volume and score <jats:italic>P</jats:italic> < 0.001) or febuxostat (<jats:styled-content style="fixed-case">MSU</jats:styled-content> volume <jats:italic>P</jats:italic> < 0.001; <jats:styled-content style="fixed-case">MSU</jats:styled-content> score <jats:italic>P</jats:italic> = 0.001). No significant decline in <jats:styled-content style="fixed-case">MSU</jats:styled-content> deposits was noted in patients who discontinued treatment.</jats:p></jats:sec><jats:sec><jats:title>Conclusion</jats:title><jats:p>These data show that lifestyle intervention and xanthine oxidase inhibitors significantly decrease the <jats:styled-content style="fixed-case">MSU</jats:styled-content> deposit burden. Hence, conventional gout therapy not only lowers serum <jats:styled-content style="fixed-case">UA</jats:styled-content> levels, but also reduces pathologic <jats:styled-content style="fixed-case">MSU</jats:styled-content> deposits.</jats:p></jats:sec>