In patients with gout who initiate urate-lowering therapy (ULT) during an acute disease flare, C-reactive protein (CRP) levels >30 mg/L and absence of prophylaxis may represent prognostic factors for early gout flare recurrence, according to a study published in Clinical Rheumatology.

For this post hoc analysis, investigators used data from a multicenter double-blind double-dummy randomized noninferiority clinical trial for which patients with gout, as assessed by the presence of crystals, treated at 1 of 7 rheumatology centers in The Netherlands, were recruited.

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Eligible patients with acute gout flare (n=75; mean age, 61.0±12.5 years; n=73 men) were randomly assigned to receive treatment with anakinra or standard of care, (ie, colchicine, naproxen, or prednisolone). The study protocol required that all patients be initiated on ULT at baseline. Data examined included baseline demographic, laboratory, clinical, and patient-reported variables, as well as assessment at 3 months of recurrence of gout flare.

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Of 75 participants, 36 (48%) experienced a gout flare ≤3 months after initiating ULT. CRP levels >30 mg/L (odds ratio [OR], 9.47) and lack of prophylaxis when initiating ULT (OR, 11.56) were found to be independently associated with the recurrence of gout flare (P ≤.10), as indicated by univariate and multivariate regression analyses.

Receiving prophylaxis at the onset of ULT was found to be strongly protective against the recurrence of gout flare. Prophylaxis In this cohort consisted of a 3-month treatment with colchicine or naproxen.

Study limitations include the lack of information on other possible predictors of gout flare (eg, presence of comorbidities, medication usage, and diet), and on the participants’ adherence to their ULT medication during the study.

“[W]e demonstrated that CRP levels >30 mg/L and lack of prophylaxis were independent, prognostic factors for early (≤3 months) gout flare reoccurrence in gout patients initiating ULT during an acute gout flare,” concluded the study authors.


Janssen CA, Oude Voshaar MAH, Ten Klooster PM, Vonkeman HE, van de Laar MAFJ. Prognostic factors associated with early gout flare recurrence in patients initiating urate-lowering therapy during an acute gout flare [published online April 27, 2019]. Clin Rheumatol. doi: 10.1007/s10067-019-04566-6