Among patients with acute gout flare, early vs late initiation of allopurinol did not show significant changes in time to resolution, flare recurrence, or inflammatory makers, according to study results published in Clinical Rheumatology.

Researchers conducted a 28-day randomized controlled trial, which included patients with crystal-proven gout who presented with acute gout flare within 72 hours of arthritis onset. Treatment with allopurinol was initiated on day 1 for the early initiation group and on day 14 for the late initiation group.

The primary study outcome was time to complete arthritis resolution; secondary outcomes included time to clinical resolution, arthritis relapse, laboratory parameters, and adverse events.


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Overall, 115 patients (58 in the early initiation group and 57 in the late initiation group) completed the study. Both groups had similar baseline characteristics and the overall median age was 62 years.

There was no significant difference in time to complete resolution: 6 days (interquartile range [IQR], 5-14 days) for the early initiation group vs 6 days (IQR, 5-7 days; P =.14) for the late initiation group. For both groups, the median time to clinical resolution was 4 days (P =.12). There was no statistical difference between the early and late initiation groups with regard to relapse of arthritis (20.69% and 15.79% respectively; P =.5), laboratory parameters, and occurrence of adverse events.

No serious adverse events occurred in both groups.

The study was limited by the need for the attending physician to determine the appropriate treatment for acute gout flare and the short-term nature of the results.

Researchers concluded, “Starting [urate-lowering therapy] during an acute gout flare did not worsen or prolong a flare, suggesting that acute gout flare might be a window of opportunity to start [urate-lowering therapy].”

Reference

Satpanich P, Pongsittisak W, Manavathongchai S. Early versus late allopurinol initiation in acute gout flare (ELAG): a randomized controlled trial. Clin Rheumatol. Published online August 18, 2021. doi:10.1007/s10067-021-05872-8