Monthly ULT Titration Improves Serum Uric Acid Levels, Ultrasound Features in Gout

In patients with gout, tight disease control is associated with statistically significant improvements in serum uric acid (SUA) levels and resolution/improvement in ultrasound features, according to results of a nonblinded randomized controlled trial — Tight Control of Gout (TICOG) —presented at the American College of Rheumatology (ACR) Convergence 2022, held from November 10 to 14, in Philadelphia, Pennsylvania.

The European Alliance of Associations for Rheumatology (EULAR) and the British Society of Rheumatology recommend optimal SUA levels of 0.30 mmol/L or lesser and 0.36 mmol/L or lesser, respectively. The 2020 ACR guidelines for gout management recommends ULT dose titration, based on serial urate measurements, with a target of 6 mg/dL or lesser (<0.36 mmol/L).

The researchers of the TICOG study compared conventional management of gout with monthly ULT titration in achieving and maintaining SUA at a target level of 0.30 mmol/L or lesser.

A total of 110 participants aged between 18 and 85 years were prospectively enrolled in the study and randomly assigned to the tight control or conventional treatment group. Data from participants in the conventional cohort were assessed at 0, 6, and 12 months with ongoing care by a family physician; those in the tight control cohort were evaluated at monthly intervals for 12 months.

All participants were initiated with treatment with allopurinol 100 mg/day plus an anti-inflammatory agent/colchicine or a steroid for flare prophylaxis; those with a contraindication to allopurinol received febuxostat 80 mg/day. However, all participants were recommended to receive urate monitoring and dose escalation until a target SUA level of 0.30 mmol/L was attained.

Researchers performed ultrasound evaluation of greyscale synovitis, erosion, and tophus that was compared at month 0 and 12.

Results of the study showed that 89.4% of participants in the tight control group compared with 39.6% in the conventional treatment group achieved a target SUA level of 0.30 mmol/L or lesser (P <.001), thus reflecting a change in SUA levels at 6 months of 37.6% and 18.0%, respectively (CI, 12.4%-26.9%).

Researchers observed a reduction in ultrasound features of gout at the knee, with improvements in 63.0% of the tight control group vs 14.0% of the conventional group (CI, 0.01%-0.97%; P <.043).

Decrease in tophus size at the first metatarsophalangeal (MTP) joint differed significantly between the tight control and conventional treatment group (median reduction, -4.65 mm and -0.30 mm, respectively; P = .003). A difference in the presence/absence of a double contour sign at the first MTP between the tight control and conventional treatment group was reported at the final visit (62.5% and 40.0%, respectively, with a double contour present).

The study authors concluded, “This study demonstrated that tight control of gout leads to highly statistically significant improvements in SUA and resolution/ improvement of ultrasound features of gout.”