Patients with gout who underwent an intensive treat-to-target regimen of monthly up-titration of urate-lowering therapy were significantly more likely to reach their goal at 1 year than those who received conventional gout management. ACR22
or NSAID prophylaxis for gout flares for the first 6 months, depending on their comorbidities.
Conventional management consisted of urate level review at 0, 6, and 12 months with up-titration at each visit and primary care management of ULT between reviews until the target serum urate level was reached. In the tight-control group, monthly up-titrations occurred at the Musgrave Park Hospital at visits with the study team that were led by a rheumatologist and a specialist pharmacist.
By 1 year, 89.4% of patients in the tight-control group had achieved the target urate level, compared with 39.6% in the conventional-management group . At 6 months, serum urate had declined by 37.6% with tight control, vs 18% with conventional management. By the end of the trial, the median allopurinol dose was 400 mg with tight control and 200 mg with conventional management . A total of 89% of patients were taking allopurinol at the end of the trial.
On blinded ultrasound evaluations, the median diameter of the first MTP tophus declined significantly more with tight control than with conventional management . Gray-scale synovitis in the knee improved in 63% of patients undergoing tight control, compared with 14% of conventionally managed patients .
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