Lisa K. Stamp

Objective: This study aimed to determine whether gout flare resolution is associated with physical activity and sleep. These findings were intended to inform the future development of a definition for flare resolution. Methods: Data from 81 participants with gout who experienced at least one flare during a six‐month prospective observational study were included. Daily activity (step count) and sleep (total sleep time and deep sleep percentage) were collected remotely using wrist‐worn trackers. Daily flare occurrence was captured using smartphone diaries. Activity and sleep outcomes during each flare episode were compared to those during three resolution timeframes: T1, the first day following the flare; T2, the consecutive window immediately following the flare and equal in length to the flare; and T3, the consecutive window equal in length to the flare and immediately following a washout window (equal in length to the flare). Adjusted differences in median between flare and resolution timeframes were estimated using linear quantile mixed models. Results: Daily step count was lower during flares compared with all resolution timeframes (all P ≤ 0.033). T3 provided the best overall model fit, suggesting that resolution is most clearly distinguished from the flare when using this timeframe. No significant differences between flare and resolution were observed for the sleep outcomes for any resolution timeframe. Conclusion: Physical activity improves soon after flare cessation, with the clearest distinction between flare and resolution observed over a longer postflare recovery period, whereas sleep metrics do not differentiate flare from resolution states. These findings support physical activity as a useful objective domain for gout flare resolution.

Objective: Current prescribing recommendations support higher doses of allopurinol in tophaceous gout to accomplish full control of gout and to lower serum uric acid to normal or near-normal levels. The aim of this study was to determine whether outcomes differ between individuals with and without tophi during 1 year of allopurinol prescribed according to a serum urate (SU) target. Methods: Individual-level participant data from 2 randomized trials of gout (n = 383) were analyzed. Both trials used a treat-to-target strategy with allopurinol and an SU target of < 0.36 mmol/L. The primary outcome was the percentage of participants at target-level SU at month 12 among those with and without tophi. Secondary outcomes included the absence of gout flares. The percentages of participants with target-level SU and the absence of gout flares were compared between those with and without baseline tophi using the Cochran-Mantel-Haenszel test, controlling for study. Results: Most participants were male, were of European ethnicity, and had longstanding gout. Tophi were present in 33% of participants. There was no statistically significant difference in the percentage of participants with target-level SU at 12 months between those with and without tophi (70.3% vs 73.6%; P = 0.76) nor in the percentage of participants without gout flares during the month before month 12 between those with and without tophi (71.4% vs 79.7%; P = 0.27). Conclusion: Despite the higher monosodium urate crystal burden in those with tophi, key gout outcomes, including urate-lowering efficacy and absence of gout flares, did not differ from those without tophi when allopurinol was prescribed.

Objective: Although the definition of a gout flare is well established, the state of gout flare resolution has not yet been defined. This study aimed to explore patients’ experiences and perceptions of gout flare resolution. Methods: Semistructured interviews were conducted with 24 people with gout, guided by open‐ended questions exploring their experiences of gout flare resolution. To facilitate discussion, participants were shown graphs depicting changes in pain intensity during a hypothetical flare. Prompts relating to key flare features, including pain, swelling, warmth, and medication use, were used as appropriate. Data were analyzed using a descriptive approach to thematic analysis to prioritize participants’ voices and experiences. Results: Four themes, closely tied to an overarching concept of a return to normality, were generated: (1) return to personal baseline pain—in which most participants required a pain score of 0 out of 10, whereas the remaining considered resolution to occur at low to moderate pain levels; (2) return of function; (3) restoration of emotional well‐being; and (4) disappearance of joint swelling, warmth, and redness. Conclusion: Flare resolution is experienced as a return to normality, encompassing relief from pain, return of mobility, restored well‐being, and the disappearance of other inflammatory features, such as swelling, warmth, and redness. Incorporating these insights into the development of a patient‐centered definition for flare resolution may support more meaningful, patient‐centered approaches to measuring and managing gout flares.

Objective: Asymptomatic hyperuricemia is a precursor of gout and is also associated with cardiovascular disease and chronic kidney disease. The aim of this study was to understand perceptions about asymptomatic hyperuricemia and views about urate‐lowering therapy in people with asymptomatic hyperuricemia. Methods: Participants in a multinational study of asymptomatic hyperuricemia completed questionnaires about their perceptions of hyperuricemia, concern about hyperuricemia‐associated health conditions, and willingness to take urate‐lowering medication. All had a screening serum urate of ≥0.48 mmol/L (8 mg/dL) and no current or previous symptoms of gout. Results: Overall, participants perceived that hyperuricemia had no or very few consequences on their life. Dietary factors were the most reported cause, whereas 37% did not know the cause. Participants reported a wide range in concern about hyperuricemia and the risk of developing gout. Concern about the risk of developing kidney disease or cardiovascular disease was also highly variable but was higher than concern about elevated serum urate ( P < 0.001). Most did not think a urate‐lowering medication was necessary, and there was moderate concern about the long‐term use of urate‐lowering medication. Medication necessity beliefs were most strongly associated with whether participants were willing to take urate‐lowering medication (partial R ² = 0.27, P < 0.001). Conclusion: Most participants perceived minimal consequences of asymptomatic hyperuricemia. Hyperuricemia was not well understood by participants, and biologic causes were generally underrecognized. Despite a range of concerns about hyperuricemia‐associated conditions, particularly kidney disease and cardiovascular disease, a urate‐lowering medication for asymptomatic hyperuricemia was not considered necessary, which aligns with most current management guidelines.

Objective: The aim of this study was to investigate the cost‐effectiveness of low‐dose colchicine prophylaxis for preventing gout flares when starting allopurinol using the “start‐low go‐slow” approach. Methods: Participants with gout, fulfilling the American College of Rheumatology recommendations for starting urate‐lowering therapy and with serum urate ≥0.36 mmol/L (6 mg/dL), were randomly allocated (1:1) to either colchicine (0.5 mg daily) or placebo for six months with a further six‐month follow‐up. All participants received allopurinol, with monthly increase in dose to achieve target urate <0.36 mmol/L. The primary outcomes were incremental cost‐effectiveness at the 6‐month and 1‐year follow‐up from the health system perspective, measured by incremental net monetary benefit (INMB) at a willingness‐to‐pay threshold equivalent to gross domestic product per capita. Results: Two hundred participants were randomized to either colchicine (n = 100) or placebo (n = 100). Mean costs were higher in the colchicine group over both six months and one year (adjusted mean difference $1,848 [95% confidence interval (CI) −$321 to $4,017] and $2,282 [95% CI −$173 to $4,737], respectively). Quality‐adjusted life years were slightly higher in the colchicine group over six months (adjusted mean difference 0.008 [95% CI −0.020 to 0.035]) but lower over one year (−0.015 [95% CI −0.039 to 0.010]). Treatment with colchicine was not found to be cost‐effective at either 6 months or 12 months (INMB −$1,373 [95% CI −$4,287 to $1,542] and −$3,191 [95% CI −$6,274 to −$107], probability of cost‐effectiveness 17.7% and 1.5%, respectively). Similar results were obtained from a societal perspective. Conclusion: Six months of low‐dose colchicine prophylaxis when starting allopurinol using the “start‐low go‐slow” approach is unlikely to be cost‐effective over 12 months.

Objective: Prior imaging studies have suggested that monosodium urate (MSU) crystal deposits in joints dissolve more rapidly than those in tendons during urate-lowering therapy (ULT) for gout. This study aimed to examine whether urate deposits visible on dual-energy computed tomography (DECT) reduce at different rates in joints and tendons during ULT. Methods: Participants with gout from 2 clinical trials of oral ULT with the following criteria were included: paired DECT scans of the feet and ankles over 1-year of ULT, first DECT scan showing total urate volume ≥ 0.5 cm ³ , second DECT scan showing reduced total urate volume, and DECT deposition visible in at least 1 joint and 1 tendon on the first scan. DECT urate volumes in up to 3 index joints and up to 3 index tendons at baseline and year 1 were measured in known order. Data were analyzed using a general linear mixed analysis of covariance. Results: In total, 125 joint deposits and 95 tendon deposits were analyzed from 50 participants. The least means change (95% CI) in DECT urate volumes of the joint deposits was −0.37 (−0.47 to −0.26) cm ³ and of the tendon deposits was −0.39 (−0.50 to −0.27) cm ³ (both P < 0.001). There was no difference in the change in DECT urate volumes between the joint and tendon deposits; least means difference was 0.02 (95% CI −0.09 to 0.13) cm ³ ( P = 0.73). Conclusion: This DECT study indicates that similar rates of MSU crystal dissolution occur at both joints and tendons during oral ULT.