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Predictors of disease activity in gout: a 12-month analysis of the ATTACk (Achieving improvement in the management of crystal-induced arthritis) multicentre cohort study

1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19
Collaborator/s: F. Salaffi1, A. Di Matteo2, E. Fusaro3, M. Govoni4, M. Manara5, A. Murgo6, L. Rotunno7, M.A. Cimmino8

 

  1. Rheumatology Unit, Department of Medicine-DIMED, University of Padova, Italy.
  2. Rheumatology Division, Multispecialist Medical Department, ASST Grande Ospedale Metropolitano Niguarda, Milan, and Epidemiology Unit, Italian Society for Rheumatology, Milan, Italy.
  3. Department of Medicine, Internal Medicine and Rheumatology Unit, Azienda Ospedaliera Universitaria di Parma, Italy.
  4. Rheumatology, Central Hospital of Bolzano, Italy.
  5. Rheumatology Unit, Department of Medicine-DIMED, University of Padova, and UO Medicina Generale, Ospedale Riabilitativo di Alta Specialità (ORAS), Motta di Livenza, Treviso, Italy.
  6. Rheumatology Unit, Department of Medicine-DIMED, University of Padova, and Internal Medicine Unit, Department of Medicine, San Bortolo Hospital of Vicenza, Italy.
  7. Rheumatology Unit, Department of Medicine-DIMED, University of Padova, Italy.
  8. Rheumatology Unit, Department of Medicine-DIMED, University of Padova, and Internal Medicine 1, Ca' Foncello Hospital, ULSS2 Marca Trevigiana, Treviso, Italy.
  9. SC Reumatologia, AOU Città della Salute e della Scienza, Torino, Italy.
  10. Rheumatology Unit, Department of Medical Sciences, University of Ferrara and Azienda Ospedaliero-Universitaria S. Anna, Cona, Ferrara, Italy.
  11. Lupus Clinic, Dipartimento di Scienze Cliniche Internistiche, Anestesiologiche e Cardiovascolari, Sapienza University of Rome, Italy.
  12. Lupus Clinic, Dipartimento di Scienze Cliniche Internistiche, Anestesiologiche e Cardiovascolari, Sapienza University of Rome, Italy.
  13. Internal Medicine Complex Structure for Rheumatology, Maggiore Hospital Bologna, Italy.
  14. Rheumatology Unit, Department of Medicine-DIMED, University of Padova, Italy.
  15. Epidemiology Unit, Italian Society for Rheumatology, Milan, and Department of Statistics and Quantitative Methods, Division of Biostatistics, Epidemiology and Public Health, University of Milano-Bicocca, Milan, Italy.
  16. Epidemiology Unit, Italian Society for Rheumatology, Milan, Italy.
  17. Epidemiology Unit, Italian Society for Rheumatology, Milan, and Rheumatology Unit, Department of Medical Sciences, University of Ferrara and Azienda Ospedaliero-Universitaria S. Anna, Cona, Ferrara, Italy.
  18. Rheumatology Unit, Department of Medicine-DIMED, University of Padova, Italy.
  19. Rheumatology Unit, Department of Medicine-DIMED, University of Padova, Italy. roberta.ramonda@unipd.it

  1. Rheumatology Unit, Rheumatology Unit, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, Ancona, Italy.
  2. Rheumatology Unit, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, Ancona, Italy.
  3. SC Reumatologia, AOU Città della Salute e della Scienza, Torino, Italy.
  4. Rheumatology Unit, Department of Medical Sciences, University of Ferrara and Azienda Ospedaliero-Universitaria S. Anna, Cona, Ferrara, Italy.
  5. Department of Rheumatology, ASST Gaetano Pini-CTO, Milano.
  6. Department of Rheumatology, ASST Gaetano Pini-CTO, Milan.
  7. Department of Rheumatology, ASST Gaetano Pini-CTO, Milano.
  8. Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genova, Genova, Italy.

on behalf of the SIR Study Group ATTACk

CER15625
2023 Vol.41, N°3
PI 0628, PF 0633
Full Papers

purchase article

PMID: 35930471 [PubMed]

Received: 24/02/2022
Accepted : 09/05/2022
In Press: 05/08/2022
Published: 23/03/2023

Abstract

OBJECTIVES:
Gout treatment is largely suboptimal in clinical practice. We aimed to assess the predictors of disease-activity at 12 months in a real-life setting.
METHODS:
Consecutive patients referred to Rheumatology Units for suspected acute crystal-induced arthritis were enrolled in a multicentre-cohort study. Only patients with clinical diagnosis of gout were eligible. Disease-activity was evaluated by the Patient Acceptable Symptom State (PASS) on a visual analogue scale (VAS, 0=unsatisfactory, 100=satisfactory) at 0 (T0) and 12 months (T12), and the composite score called Gout Activity Score (GAS) calculated on the number of arthritic attacks (flare count), serum uric acid (sUA), cumulative number of tophi, VAS (T12), PtGA (T12). Multivariate linear regression model was performed to assess predictors of gout disease-activity at T12 with PASS and GAS as outcomes.
RESULTS:
201 patients had gout (diagnosis on synovial fluid in 45%, tophi in 26%, mean sUA 7.4±1.9 mg/L, 85% with urate-lowering therapy (ULT) in progress/initiated at T0); mean age 63±13 years, 88% men, median (interquartile range) disease duration 2.9 years (0.7-9.4). Follow-up visits were performed in 113 (56%) patients at T12. Mean PASS observed at T0 and at T12 were 38±27 and 74±23, respectively, whereas GAS at T12 was 10±8. A significant association was observed between the presence of tophi and PASS at T12 (-15.3, 95% CI -25.5, -5.2; p=0.003) and GAS at T12 (+4.0, 95% CI 0.6,7.4; p=0.02), adjusted for age, sex, disease duration, sUA <6 mg/dL, tender joint count, PASS at T0, ULT).
CONCLUSIONS:
The baseline presence of tophi may predict high disease-activity at T12, thus worsening GAS and patients’ pain perception.

DOI: https://doi.org/10.55563/clinexprheumatol/eh0jcp

Rheumatology Article