Two factors predict early gout flare recurrence when starting urate-lowering therapy

Early gout flare recurrence in patients who initiate urate-lowering therapy (ULT) during an acute disease flare is predicted by C-reactive protein (CRP) levels and use of prophylaxis, according to a Dutch study.

Gout flare recurrence occurred in 48% of patients within three months of starting urate-lowering therapy during an acute gout flare, a study of 75 patients in seven rheumatology clinics in the Netherlands found.

In multivariate analysis, early gout flare recurrence was independently predicted by a CRP level >30mg/L and lack of use of prophylaxis.

Early recurrence was ten times more likely in patients who had CRP levels >30mg/L (Odds Ratio 9.47) compared to those who had lower levels. Conversely, early gout flare recurrence was twelve times less likely (OR 11.56) among patients who started prophylaxis with agents such as low dose colchicine and naproxen compared to those who did not receive prophylaxis.

The study published in Clinical Rheumatology, was conducted in patients with crystal-proven gout who initiated urate lowering therapy, mostly with allopurinol at a starting dose of 100mg (78%) or 300mg (18%).

Of the patients who had an early gout flare recurrence, 67% had one flare and 28% had two flares.

In contrast to previous studies, increased serum urate levels were not prognostic for the recurrence of a gout flare in the short term, although this may have been because most patients had a high baseline serum urate level (mean 50mmol/L).

The study authors said their findings highlighted the importance of prophylaxis when initiating ULT, as is currently recommended by gout management guidelines.

The potential role of CRP for predicting gout flares should be explored in further studies that also investigate the role of other factors such as serum urate levels and co-morbidities, they suggested.

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