Optimal serum urate targets may change with stages of gout treatment
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WASHINGTON — Different stages of gout treatment may call for different serum urate targets, with certain levels being better for dissolving or preventing monosodium urate crystals, according to data presented at ACR Convergence 2024.
“In clinical management of gout, urate-lowering therapy dissolves monosodium urate crystals, which in turn leads to suppression of gout flares and regression of tophi,” Nicola Dalbeth, MBChB, MD, FRACP, FRSNZ, head of the department of medicine at the University of Auckland, in New Zealand, told Healio. “However, the optimal serum urate concentration to achieve crystal dissolution in vivo remains uncertain.”
To assess the volume of monosodium urate crystals at various serum urate concentrations, Dalbeth and colleagues analyzed data from three studies comprising 251 people with gout. Serum data from study participants were compared with serial dual-energy CT scans of both feet over a 12-month period of stable urate-lowering therapy.
Meanwhile, the researchers employed a mixed-models analysis of covariance approach to analyze changes in crystal volume over the course of the study, compared with mean serum urate cut-points and mean serum urate bands.
According to the researchers, there were significant reductions in crystal volumes below the cut-points compared with above. Those with mean serum urate at or above 8 mg/dL demonstrated significant crystal volume increases. Meanwhile, crystal volumes were significantly reduced among those with mean serum urate concentrations less than 4 mg/dL as well as between 4 mg/dL and 4.9 mg/dL. Crystal volumes increased above a mean serum urate level of 7 mg/dL and further above 8 mg/dL.
Overall, the findings demonstrate crystal dissolution over 1 year with serum urate below 5 mg/dL, and once they are dissolved, a higher target of 7 mg/dL “may be sufficient to prevent crystal formation,” the researchers wrote.
Dalbeth added she “was surprised” there were not significant reductions in crystal volume at mean serum urate levels between 5 mg/dL and 5.9 mg/dL.
“Importantly, the study results reflect changes in monosodium urate crystal volume over just 1 year,” she said. “Significant changes in dual-energy CT urate volumes may occur over longer time points with serum urate concentrations in this range.”
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Kelly B. Abstract #2559. Presented at: ACR Convergence 2024; Nov. 14-19, 2024; Washington, D.C.
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